Pneumococcal meningitis. The problem of high mortality

Pneumococcal meningitis

The clinical picture of meningitis consists of general infectious, meningeal and cerebral symptoms. The general infectious syndrome is characterized by lethargy, febrile temperature with chills, anorexia and refusal to drink, and pale skin. Hectic temperature is possible with fluctuations of 2-3°C. There is a change in pulse with a tendency to bradycardia, muffled heart sounds, and fluctuations in blood pressure. With the development of sepsis, pneumococcal meningitis is accompanied by a skin rash. The rashes are hemorrhagic in nature and may begin with roseolous-papular elements. Unlike the rash associated with meningococcal meningitis, the pneumococcal rash is more persistent; upon recovery, its reverse development does not occur as quickly.

The cerebral syndrome is dominated by headache (cephalgia). It is of a spreading, diffuse nature, sometimes localized mainly in the frontotemporal areas of the head. It is accompanied by repeated or repeated vomiting that does not bring relief to the patient, and expansion of the venous network on the eyelids and head. Disturbances of consciousness are possible, ranging from psychomotor agitation to stupor and coma. Convulsions of varying severity from muscle twitching to a generalized seizure may be observed. In infants, there is a divergence of the cranial sutures, bulging of the fontanelles, and a typical “brain” cry, distinguished by its shrillness and monotony. The development of meningoencephalitis leads to the appearance of focal symptoms against the background of general cerebral symptoms - oculomotor disorders, ataxia, hemiparesis, hyperkinesis.

The meningeal symptom complex is characterized by a forced position of the patient - with the head thrown back, limbs bent and brought towards the body. Hyperacusis, hyperesthesia and photophobia are observed. Rigidity of the neck muscles is typical, which is determined when the patient's head is passively tilted so that his chin approaches the chest. The so-called meningeal symptoms. Kernig's sign is the inability to passively fully extend the leg at the knee if it is bent at the hip, checked while lying on your back. Brudzinski's sign I is flexion of the thigh and lower leg when the patient attempts to passively flex the patient's head. Brudzinski's sign II is a similar bending of the legs when the doctor presses on the patient's symphysis pubis. Brudzinski's sign III - an attempt to bend the leg at the knee leads to bending at the knee and adduction of the second leg to the stomach. Mondonesi's sign is pain when pressing on closed upper eyelids. Bekhterev's symptom is painful tapping of the zygomatic arch.

In infants, Lessage's symptom is determined - pulling the legs towards the stomach while holding the child by the armpits in a suspended vertical position. In early childhood, complete meningeal syndrome is quite rare. Most often, with meningitis in infants, along with Lessage's symptom, nuchal rigidity is detected, less often - Kernig's symptom.

Flow options

Acute pneumococcal meningitis manifests itself with a sharp rise in temperature to 39-40°C and a rapid increase in general infectious symptoms. A general cerebral symptom complex is observed - intense headache, anxiety, vomiting, and in infants - a “brain” cry. Meningeal syndrome usually occurs on days 2-3 of illness. Depression of consciousness progresses, focal symptoms arise. On days 3-4, a convulsive-comatose status is noted. Dislocation of cerebral structures with herniation of the brain stem into the foramen magnum is possible, which can cause death.

Pneumococcal meningitis, which appears against the background of the primary focus of pneumococcal infection, is characterized by a subacute and asymptomatic onset. But it is more severe than the primary acute form and more often leads to death. This is usually due to late recognition of meningitis and, accordingly, late initiation of its therapy.

Adequate and timely treatment begins to lead to some improvement in the patient’s condition by the end of 1 week of illness. Within 2 weeks, regression of cerebral and meningeal symptoms occurs. However, pneumococcal meningitis often has a protracted course or relapses are observed. The liquor is sanitized for 3-4 weeks of illness.

Risk group for contracting pneumococcal meningitis

As already mentioned, young children are susceptible to infection. However, the risk group includes all citizens of any age, but with weakened immunity.

So, the risk group includes:

1. Children from six months to 2 years. Due to the presence of maternal antibodies in the newborn's body, his immunity has a certain protection. Within six months from the day of birth, children lose antibodies, and accordingly their immunity can no longer protect itself from the invading pathogen.
2. Children aged 10 years and older and adults who have been diagnosed with immunodeficiency due to various diseases.
3. Age-related immunodeficiency is characterized by a group of people over 65 years of age.
4. People with alcohol addiction, as well as heavy smokers, are at risk.

The manifestation of pneumococcal meningitis can be dangerous due to its long incubation period. Moreover, there is a characteristic division of the described disease into two forms: primary and secondary. The primary form is not detected by standard bacteriological studies: taking a culture from the nasal or oral cavity, pneumococcus is not detected. This means that after the events that provoke the presented form of the disease, the course of the disease will be very severe, and most importantly, it can be rapid in nature and increases the likelihood of death.

Diagnostics

When infected with pneumococcus, urgent medical care is required, which cannot be provided without preliminary diagnosis. Pneumococcal infection spreads quickly in the body, causing various pathologies and possible complications.

During the consultation, the doctor collects anamnesis from the patient’s words, examines the patient, and then additional diagnostic measures are carried out to exclude diseases caused by pneumococcus:

• blood and urine tests;
• bacteriological control test, throat swab;
• spinal tap;
• immunodiagnostics, bacterial culture;
• MRI, CT, ultrasound of affected organs.

The clinical diagnosis is made on the basis of pneumococcal symptoms. Diseases caused by bacteria of the genus Streptococcus pneumoniae are difficult to distinguish from other bacterial infections, so the doctor should gradually exclude other forms of pneumonia, meningitis and other viruses.

The final diagnosis is made after obtaining laboratory tests, on the basis of which treatment measures are carried out.

Causes

Streptococcus pneumoniae - opportunistic microbes - live in the body for a long time. Infectious agents are activated by the following factors:

• hypothermia;
• constant colds;
• chronic fatigue syndrome;
• stress, depression, neuropsychiatric disorders;
• insufficient, incorrect nutritional diet;
• presence of injuries;
• reduction of the body's protective functions;
• nicotineism;
• large crowds of people;
• hypovitaminosis;
• polluted environment.

Immunization against pneumococcal infection

After the advent of immunobiological drugs against pneumococcus, many doubt the need for vaccination. Pros and cons of vaccination against Streptococcus pneumoniae:

1. A person becomes infected through aerogenous means; it is impossible to avoid infection;
2. There are several types of pneumococci that cause serious complications;
3. Bacteria of the genus Streptococcus pneumoniae primarily affect children and the elderly, and vaccination protects people at risk;
4. Due to the mutation of pneumococcal microorganisms, the disease is more difficult to treat each time - many dangerous pneumococci are resistant to antibiotics. The vaccine promotes the production of antibodies against insidious microorganisms;
5. Pneumococcal infection can lead to death. As a result of vaccination, the concentration of pneumococci in the body decreases in carriers, therefore, the spread of infection is minimized;
6. Side effects after vaccination are small: hyperemia at the injection site, itching, and increased body temperature are possible. Revaccination is not done in case of hypersensitivity. The vaccine is killed bacteria (conjugated, Prevenar) or bacterial parts (polysaccharide Pneumo-23, Synflorix), so after vaccination it is impossible to become infected with pneumococcal infection.

In addition to vaccination, you should adhere to a healthy lifestyle - eat, exercise, strengthen your immune system.

All about meningococcal and pneumococcal infections

Nelly, Moscow

November 21, 2019

I ask you to! If it’s not difficult for you, if there is such an opportunity! Explain, tell, can calm you down! Here's the thing. Now the media and the Internet are again creating panic about the epidemic of meningococcal infection. This year, mycoplasma pneumonia and whooping cough were added to it. Meningococcus is especially dangerous. Maybe there are some statistics, scientific articles where you can read about this? I'm interested in everyone who is at risk? Who is more susceptible and at what age? Yesterday I read on social networks how a girl talks about her cousin: that there were no symptoms! He suddenly grabbed his head and started screaming in pain! They didn’t take me to the hospital (I’d like to know how they act in such cases! Our pediatrician recommended that I have the antibiotic “ceftriaxone” at home, but when and in what cases should I use it? How to dilute it? And have something hormonal! I also read that you can use drops for prevention Levomecetin! This is what doctors do after contact. How many times and in what dosage should I use all this? I’ll tell you a little about myself and my family: We live in 4, our 18-year-old daughter is fully vaccinated and a year ago she received Minactra (I understand correctly that it cannot be with the vaccine carrier and bring something into the house) My husband always has a chronic runny nose. I have no spleen (I also wonder what vaccinations I need?) The youngest is 4.3 years old, for whom the biggest concern is because she has JRA disease and uveitis. We accept therapy Methodoject and Humira. She has been sick since 1.8. Before this, they managed to get the following vaccinations: Hepatitis-4 Polio-4 DPT-3 Russia + 1 Pentaxim + Hib Previnar 13 -2 pcs Measles, crones, mumps. Also in the month of May, IVs were given - human immunoglobulin. With such a set of vaccines, are we at least somewhat protected? From this infection! We also tested for infections: toxoplasmosis, chlamydia, mycoplasma and enterovirus CMV, EBV et HSV) from 04/24/17. With negative IgM, positive IgG to CMV (22 UA/ml) MSV (52.5 S/co) With negative IgG, positive IgM to Mycoplasma pnevmonie (19.2 ) ELISA for mycoplasma infection from 05/03/17 with negative IgG, positive IgG to mycoplasma pnevmanie (20.2) What does this mean? It turns out we got sick with this microplasma pneumonia? And she’s not afraid of us? How long does immunoglobulin last? Is it worth digging again? We were digging about herpes type 1-2 on the butt, jumping up all the time. As far as I understand, there is protection from measles up to 7 years of age? What other methods can you suggest for prevention? In addition to vaccination (medical withdrawal), any information would be interesting and useful to me. I feel so much calmer! Thank you so much for reading to the end! And thank you very much in advance!

The question is closed

meningococcus pneumococcus

Treatment

In acute cases of pneumococcal infection, hospitalization is necessary. In other cases, the patient is prescribed bed rest with proper nutrition, large fluid intake, and the exclusion of food allergens. So that during illness and subsequent prevention the nutritional diet is balanced.

In the treatment of diseases caused by Streptococcus pneumoniae, the following methods are followed:

1. Etiotropic therapy - taking antibacterial agents;
2. Detoxification treatment;
3. Relief from symptoms.

Etiotropic therapy is determined by antibacterial treatment of the patient. Streptococcus pneumoniae is resistant to a number of antibiotics:

• penicillin - Amoxiclav, Ospamox;
• cephalosporin - Cefuroxime, Ceftriaxone;
• fluoroquinolone - Levofloxacin;
• carbapenems - Imipenem, Meropenem.

During detoxification treatment, medications are prescribed aimed at:

1. Improving blood circulation - Flexital, Cinnarizine;
2. Neutralization of toxic substances - intravenous injections with colloid and crystalloid solutions;
3. Restoring heart rate - Mildroxin, Riboxin, Magnerot;