- Symptoms of Bacterial meningitis
- Reasons of Bacterial meningitis
- Treatment of Bacterial meningitis
Meningitis can be the main or only display of bacteremia. Entrance gate of contagiums at meningitis are a mucous membrane of a nasopharynx (with emergence of a nasopharyngitis, quinsy), bronchial tubes (at bronchitis), digestive tract with disorders of its function and the subsequent hematogenous or lymphogenous distribution of the activator to a meninx.
Symptoms of Bacterial meningitis:
Meningitis of a bacterial origin is usually characterized by the acute beginning, the expressed meningeal symptoms and cellular reaction in liquor with dominance of polinuklear. An important exception is tubercular meningitis which develops more gradually and is characterized by a mononuclear pleocytosis. Sugar level at the majority of bacterial meningitis is reduced, and a squirrel - is moderately increased. Other forms of meningitis caused by viruses, spirochetes, rickettsiae, mushrooms and protozoa are less bright on the manifestations, than acute bacterial meningitis. Their clinical signs are variable, in cerebrospinal liquid the cytosis is more often mononuclear, the level of sugar is reduced not so sharply.
Kernig's sign. Consists in impossibility to unbend the patient's leg in a knee joint when it is bent in coxofemoral. Interferes with extension not pain, but tension of back group of muscles of a hip (a tonic obolochny reflex). Is one of the most frequent and constant symptoms of meningitis.
Upper symptom of Brudzinsky — at passive reduction of the head of the patient to a breast, in a dorsal decubitus, his legs are bent in knee and hip joints.
Average symptom of Brudzinsky — the same bending of legs when pressing on a pubic joint.
The lower symptom of Brudzinsky — at passive bending of one leg of the patient in knee and coxofemoral joints other leg is bent similarly.
The Podskulovy (buccal) symptom of Brudzinsky — when pressing on the patient's cheeks directly under cheekbones occurs a reflex raising of shoulders and bending of forearms (owing to a peculiar pose this symptom is called still a symptom of "cross").
Giyen's symptom — squeezing of four muscles of a hip of the patient on the one hand causes involuntary bending in coxofemoral and knee joints of an opposite leg.
Hermann's symptom — (a symptom "a neck — a foot thumb") — at passive bending of a neck at the patient is observed an ekstenziya of thumbs of feet; the symptom is described by the Polish neuropathologist Jewfimius Hermann at a tubercular encephalomeningitis.
Symptom of "suspension" of Le Sage. The newborn child is taken for axillary hollows both hands, holding with index fingers the head from a back, and raise that leads to involuntary pulling up of legs to a stomach due to bending them in coxofemoral and knee joints and their long fixing in such bent situation. At the healthy child at test Le Sage of a leg freely move (are bent and unbent).
Symptom of Mondonezi — pressing on eyeballs through the closed eyelids is painful.
Reasons of Bacterial meningitis:
The inflammation and hypostasis of a meninx, and also adjacent tissue of a brain, disorder of microcirculation in the shell and brain vessels, hypersecretion of cerebrospinal liquid and delay of its resorption belong to pathogenetic mechanisms of clinical displays of meningitis that leads to development of an edema of a brain and increase in intracranial pressure. The irritation of sensitive receptors of covers of a brain and the roots of cranial and spinal nerves pro-butting covers also have the features of clinical manifestations.
Bacterial meningitis meningokokk, pneumococci, a hemophilic stick, staphylococcus, and also streptococci, salmonellas, a pyocyanic stick can cause, klebsiyella.
Treatment of Bacterial meningitis:
Treatment needs to be begun with penicillin because nearly 90% of purulent meningitis are caused by meningokokka, pneumococci, stafilokokka and to streptococci, and they are highly sensitive to this antibiotic. Penicillin should be entered intramusculary at the rate of 260 000 — 300 000 PIECES on 1 kg of body weight a day. Children of the first months should enter penicillin each 3 h, and for adults intervals between injections should not exceed 4 h. Intramuscular administration of penicillin can be combined with endolumbar (5 000 — 30 000 PIECES depending on age) after preliminary cerebral decompression and removal of the toxic products which are contained in pathological cerebrospinal fluid. Such medical punctures can be carried out daily in the first 3 days of a disease, then three times every other day.
V. I. Pokrovsky and Yu. Ya. Vengerov in 1973 carried out assessment of results of treatment of a meningococcal infection various antibiotics. According to these authors, at treatment massive to penicillin doses by-effects in the form of allergic rash were observed at 1,1% of patients, but only in isolated cases replacement of an antibiotic was required. When using penicillin endotoxic reactions, in particular manifestations of shock at patients with a meningokokkomiya and wet brain at patients with meningitis quite often amplified.
It is also possible to apply to treatment of spotted fevers semi-synthetic penicillin, but according to V. I. Pokrovsky and Yu. Ya. Vengerov, they are less effective, than benzylpenicillin. It is necessary to appoint them at the meningitis caused by strains of a meningokokk, steady against penicillin. It is necessary to remember that penicillin causes allergic reaction which can be observed also in relation to semi-synthetic penicillin in many patients.