Purulent meningitis

Description:

This purulent inflammation of a meninx. In the world 3-10 cases of a spotted fever on 100 000 population are registered.

Symptoms of Purulent meningitis:

Incubation interval – 1-5 days. The disease develops sharply: the strong fever, body temperature raises to 39-40 °C. Appears and quickly the intensive headache with nausea or repeated vomiting accrues. The nonsense, psychomotor excitement, spasms, consciousness disturbances are possible. During the first hours the shell symptoms (nape muscle tension, Kernig's signs) accruing by 2-3rd day of a disease come to light. Deep reflexes are recovered, belly - are lowered. At a heavy current damages of cranial nerves, especially III and VI couples (a ptosis, an anisocoria, squint, a diplopia) are possible, is more rare - VII and VIII couples. For the 2-5th day of a disease herpetic rashes on lips often develop. Sometimes there are also various skin rashes (more often at children) hemorrhagic character that testifies to a meningokoktsemiya. Cerebrospinal liquid muddy, purulent, follows under supertension. Are found a neutrophylic pleocytosis (to several tens of thousands cells in 1 мкл), the increased protein content (to 1-16 g/l), the lowered level of sugar and chlorides. In liquor deposit smears after coloring on Gram find менингококк. It can also be allocated from the slime taken from a throat. In blood - a leukocytosis (to 30 - 109/l) and increase in SOE.

On expressiveness of clinical symptomatology allocate easy, moderately severe and heavy forms meningococcal meningitis. Along with defeat of covers of a brain marrow also is involved in process that is clinically shown from the first days of a disease by consciousness disturbance, spasms, paresis at weak expressiveness of a meningeal syndrome. Visual and auditory hallucinations, and further - a dysmnesia and behavior are possible. Hyperkinesias, increases in a muscle tone, frustration of a dream, an ataxy, a nystagmus and other symptoms of defeat of a brain trunk are observed. In such cases the encephalomeningitis differing in a heavy current and the bad forecast, especially at emergence of signs of development of an ependimatit (ventrikulit) is diagnosed. A peculiar pose at which extensive contractures of legs and flexion - hands, a spasm like gormetoniya develop hypostasis of disks of optic nerves, increase of amount of protein in liquor and its xanthochromatic coloring is characteristic of an ependimatit.

Treat acute wet brain with a secondary trunk syndrome early complications of a spotted fever and acute adrenal insufficiency (Waterhouse-Frideriksen's syndrome). Acute hypostasis of a brain can arise at a fulminant current or for the 2-3rd day of a disease. Main signs: consciousness disturbance, vomiting, motive concern, spasms, respiratory and cardiovascular frustration, increase in arterial and likvorny pressure.

Reasons of Purulent meningitis:

The gram - a negative diplococcus - meningokokky Veykselbauma is caused. The disease is transmitted in the drop and contact way through the objects which were in the use at the patient. Entrance gate is the mucous membrane of a pharynx and a nasopharynx. Meningokokki get into a nervous system in the hematogenous way. Not only sick, but also healthy kokkonositel are a source of an infection. Most often get sick with meningitis in the winter and in the spring. Sporadic diseases are observed at all seasons of the year.

Treatment of Purulent meningitis:

Treatment at purulent meningitis has to be bystry and accurate. In most cases the patient should be hospitalized. Appoint specific and symptomatic therapy. A nosotrophy same, as well as at other acute infections. Antibiotics begin immediately after a lumbar puncture and an intake of material for a bacteriological research and definition of sensitivity of microflora.

To children appoint ampicillin on 300-400 mg/kg/days and cephalosporin III of generation (to tsefataksy 200 mg/kg/days there are each 4-6 hours or цефтриаксон on 100 mg/kg/days each 12-24 hours). A course of treatment – 2-3 weeks.
The adult each 4-6 hours or ampicillin of 12-18 g/days each 4-6 hours or a tseftriakson of 4 g/days each 12 hours combine penicillin G (benzylpenicillin sodium salt) 18 - 24 million PIECES/days. A course of treatment - 10 days.

At meningitis of a collibacillary etiology appoint Morphocyclinum, levomycetinum гемисукцинат (chloramphenicol), Kanamycinum. At infection with a pyocyanic stick apply polymyxin - M. V cases of influenzas meningitis drug of the choice is levomycetinum гемисукцинат (chloramphenicol). At staphylococcal meningitis endolyumbalno enter цепорин (Cefaloridinum), Oleandomycinum, Olemorphocyclinum.

High performance of streptocides of the prolonged action (Sulfamonomethoxinum, Sulfapyridazinum, sulfadimethoxine) is known. These drugs are appointed inside according to the scheme: in the 1st days on 2 g 2 times, in the next days - on 2 g of 1 times in days. However they can be applied only in the absence of disturbances of consciousness and vomiting.