Meningococcemia in children and adults. Symptoms Complications. Lightning form. Urgent Care. Photo

How does meningococcemia develop?

From the lesion with macrophages in which viable bacteria are preserved, or through the lymphatic tract, meningococci enter the blood. Meningococcal sepsis or meningococcemia develops. The spread of infection is facilitated by many factors: the virulence of pathogens, the massiveness of the infectious dose, the state of the body’s immune system, etc. During the period of meningococcemia, foci of secondary lesions and immunological reactions are formed. The disease progresses rapidly, unpredictably and is always very difficult.

The massive death of meningococci and the release of endotoxin is accompanied by toxic reactions. The acid-base state, hemocoagulation, water-electrolyte balance, the function of external and tissue respiration, and the activity of the sympathetic-adrenal system are disrupted.

Endotoxin of pathogens affects blood vessels, stasis and multiple hemorrhages are formed in the skin, mucous membranes and internal organs. Intravascular coagulation syndrome (DIC) develops. Hemorrhage into the adrenal glands leads to the development of Waterhouse-Friderichsen syndrome and infectious-toxic shock. Internal organs are affected, dysfunction of which leads to the death of the patient.

Rice. 2. The photo shows meningococcemia in children. Extensive hemorrhages are visible on the skin. The photo on the left shows skin necrosis.

Meningitis

The source of the disease are patients with generalized forms of meningococcal infection, acute nasopharyngitis and “healthy” carriers.

There is a fairly wide ratio between patients and bacteria carriers (1:2000 - 1:50,000). During periods of outbreaks, up to 3% of the population of bacteria carriers is registered, during epidemics - up to 30%. The carrier period is about 3 weeks. In 70%, bacterial carriage ceases within 1 week.

In patients with chronic diseases of the nasopharynx, this period is significantly longer. The most virulent strains are isolated by patients with generalized forms. Despite this, their rapid hospitalization and isolation do not have such an impact on the spread of infection as it does in “healthy” carriers.

Meningitis carriers are identified during mass examination of individuals from foci of the disease or accidentally, during examination of smears taken from the mucous membrane of the nasopharynx. Carriers of meningococci do not have any symptoms of the disease. The more severe the epidemic situation, the more carriers of the infection are identified in groups.

Out of 200 bacteria carriers, 1 bacteria carrier gets sick.

Rice. 3. The mechanism of transmission of meningococcal infection is aerosol (droplet).

Signs and symptoms of meningococcemia

The incubation period for meningococcemia ranges from 5 to 6 days. Fluctuations range from 1 to 10 days. The onset of the disease is most often acute and sudden. The generalization of the process is indicated by the deteriorating general condition of the patient, a significant increase in body temperature, increasing headache, increasing pallor of the skin, tachycardia and shortness of breath. Muscle and joint pains, rashes on the skin and hemorrhages on the mucous membranes appear.

A rash with meningococcemia appears in the first hours of the disease. Hemorrhagic elements can be enormous in size and accompanied by skin necrosis. Along with the hemorrhagic rash, hemorrhages are observed in the conjunctiva of the eyes and sclera, mucous membranes of the nose and pharynx, and internal organs. Sometimes gastric, nasal and uterine micro- and macrobleedings and subarachnoid hemorrhages occur.

An extremely severe form of meningococcemia is complicated by damage to the heart and its membranes, thrombosis of large vessels, infectious-toxic shock, hemorrhage in the adrenal glands (Waterhouse-Friderichsen syndrome). Violations of the functions of vital organs lead to the death of the patient.

In some cases, there is a milder course of the disease and atypical meningococcemia, which occurs without skin rashes. In this case, the clinical picture of the disease is dominated by symptoms of damage to one or another organ.

Very rarely, meningococcemia can become chronic or recurrent. The disease occurs with low-grade fever, often with a rash and joint damage. The disease lasts for months and even years. Months after the onset of the disease, the patient may develop endocarditis and meningitis. Periods of remission are characterized by the disappearance of the rash and normalization of body temperature. With chronic meningococcemia, erythema nodosum, subacute meningococcal endocarditis and nephritis can develop.

Rice. 3. The photo shows a chronic form of meningococcemia.

What kind of disease is this?

ATTENTION : Meningitis is a dangerous infectious disease that is transmitted by airborne droplets or through household items. Most often, the disease is diagnosed in preschool children.

Quite often, the pathological process begins with symptoms of nasopharyngitis, and only then vomiting, rash, and headache are added. The rash with meningitis on the first day of illness is very similar to the rash with measles.

Watch a video about the symptoms of meningitis:

Rash due to meningococcal infection

Under the influence of endotoxin, which is released during the mass death of meningococci, the walls of arteries and arterioles are damaged and their permeability increases. Intravascular coagulation syndrome (DIC) develops. The blood clotting system starts. Blood clots form in the blood vessels, which significantly impedes blood flow. As a compensatory mechanism, the body activates the anticoagulant system. The blood begins to thin out, causing blood clots to form in the patient’s body and bleeding to develop.

The rash due to meningococcal infection has the character of hemorrhages (bleeds), which appear on the skin and internal organs and have different sizes. Hemorrhages in the adrenal glands are especially dangerous. The developed Waterhouse-Friderichsen syndrome and dysfunction of vital organs lead to the death of the patient.

Rice. 4. The photo shows hemorrhages in the peritoneum (left) and the mucous membrane of the tongue (right).

A rash with meningococcal sepsis appears already in the first hours of the disease. Initially on the distal limbs and then spreads throughout the body.

Its signs:

Petechiae are pinpoint hemorrhages in the skin and mucous membranes.
Ecchymoses are small hemorrhages (from 3 mm to 1 cm in diameter).
Bruises are large hemorrhages.

With significant skin lesions, necrosis appears - difficult-to-heal ulcers, in the place of which keloid scars remain during healing.

Rice. 5. The rash due to meningococcal infection has a purplish-red color and does not disappear with pressure.

The elements of the rash are dense to the touch, rise above the skin, and have a star-shaped shape. The rash of meningococcemia sometimes appears on the face and ears. Rash-free skin is pale in color. Often, before the rash appears on the skin, hemorrhages appear on the mucous membranes of the oral cavity, conjunctiva and sclera. When the choroid of the eyeball becomes inflamed, the iris becomes rusty in color.

The more severe the meningococcemia, the larger the area of bruising. Huge rashes are always accompanied by the development of infectious-toxic shock.

As the patient recovers, petechiae and ecchymoses become pigmented. A small rash goes away within 3 days, a large rash within 7-10 days. Large bruises become necrotic and crusty. After the crusts are rejected, tissue defects of varying depth remain, healing with a scar. Damage to the skin of the tip of the nose, ears and phalanges with a finger occurs as dry gangrene.

In severe forms of meningococcemia, bleeding develops: uterine, nasal, gastrointestinal, and hemorrhages appear in the fundus. With hemorrhages in the adrenal glands, Waterhouse-Friderichsen syndrome develops.

Rice. 6. Rash due to meningococcemia. Point and small hemorrhages in the skin.

Rice. 7. Large hemorrhages on the skin with meningococcal sepsis take on a star-shaped shape.

Rice. 8. The photo shows the symptoms of meningococcemia: large hemorrhages on the skin of the extremities.

Rice. 9. Meningococcemia in children. Extensive hemorrhages in a child with a severe form of the disease (left) and minor hemorrhages in the skin (right).

Rice. 10. The photo shows necrosis and crusts at the site of extensive hemorrhage in severe meningococcemia in children.

Rice. 11. The photo shows a severe form of meningococcemia in a child. The skin over the extensive bruise is necrotic.

Rice. 12. After healing of deep tissue defects after meningococcal infection, keloid scars develop.

How to distinguish a dangerous sign from similar ones?

It is important to remember that not only meningitis is manifested by a skin rash . You need to know how to distinguish a dangerous hemorrhagic rash due to meningitis from rashes due to allergies, chickenpox, rubella and others. Common childhood illnesses that may cause rashes:

Chickenpox.
Measles.
Mononucleosis.
Various allergies.
Rubella.
Scarlet fever.
Pyoderma.

The difference between a meningeal rash and a rash with chickenpox is that with smallpox it is blistered and covers the entire body of the child.
It is localized without any pattern, and first appears as small red spots that form papules, and then vesicles containing clear liquid. After the vesicles burst, crusts form. With meningitis, the rash is localized in certain parts of the body, has a dark red color, and does not have blisters. With smallpox the rash is itchy and itchy, with meningitis it is not.
A distinctive feature of the measles rash is a rapid transition from red or purple to dark, almost black. Forms papules, which is not typical for meningeal. With measles, the rash is located on the face. With meningitis, a rash on the face is very rare.
With a mononucleosis rash, there is no itching or irritation, as with a meningeal rash, but when pressed, the mononucleosis rashes turn pale. The spots are reddish in color and clusters can be located on any part of the body.
An allergic rash, as a rule, does not cause a general infectious syndrome in the patient. An infectious rash, on the contrary, is accompanied by fever, weakness, and headache. The main difference between an allergic rash and a meningitis rash is itching.
In children, rubella spots do not merge into a single whole, and the rash appears some time after the onset of the disease. With meningitis, a rash is one of the first symptoms. Rubella is accompanied by a runny nose, sore throat, and other symptoms not characteristic of meningitis.
Scarlet fever is caused by streptococci, they can also cause meningitis, but with scarlet fever the rash is accompanied by slight itching and is often localized in the groin area or armpits. The rash is pinpoint and can cover any skin folds, face, thighs. The rash with meningitis does not itch and looks more like stars.
With pyoderma, formations spread throughout the body in the form of blisters with pus, then they dry out and turn yellow.

Signs and symptoms of meningococcal infection in heart disease

Meningococcal toxin contains an allergenic substance, which leads to pronounced sensitization of the body from the moment it colonizes the nasopharynx. The formed immune complexes settle on the walls of blood vessels, increasing the damaging effect (Schwartzman-Sanarelli syndrome). Sensitization of the body underlies the development of arthritis, nephritis, pericarditis, episcleritis and vasculitis.

Meningococcal carditis accounts for half of all cases of damage to internal organs due to meningococcal infection. Toxic damage to the heart affects the endocardium, pericardium and myocardium. The contractility of the heart muscle decreases, and the heart rate increases. Hemorrhages into the heart muscle, tricuspid valve and subendocardial space lead to the development of cardiac weakness, which is often the cause of death of the patient.

When infection enters the pericardium, purulent pericarditis develops. On auscultation, a pericardial friction rub is heard.

Elderly people often develop myocardiosclerosis after an illness.

Rice. 13. The photo shows hemorrhages in the endocardium (left) and pericardium (right) with meningococcal sepsis.

Consequences of meningitis and encephalitis

The prognosis for meningococcal meningitis in the case of timely and adequate treatment is favorable. In case of delayed diagnosis and delayed treatment, serious complications develop.

The consequences of meningitis are unpredictable and varied. Currently, complications of the disease associated with organic brain damage - hydrocephalus, mental retardation, dementia and amaurosis (damage to the optic nerve and retina of the eye) are very rarely observed. Complications of a functional nature are more often observed - asthenic syndrome and mental retardation. Complications of a functional nature are more often observed: asthenic syndrome, neurosis-like states, mental retardation.

Rice. 10. The photo shows the consequences of meningitis - damage to the VI pair of cranial nerves (convergent strabismus).

Cerebrasthenic syndrome

Emotional-volitional and behavioral disorders, headaches, sleep disorders, autonomic disorders and headaches are the main components of cerebrasthenic syndrome.

Cerebrasthenic syndrome, as a consequence of meningitis, manifests itself in two forms - hyperdynamic and hypodynamic.

The hyperdynamic form of cerebrasthenic syndrome is characterized by increased excitability, motor disinhibition, uncontrollability, and emotional lability. Often children begin to show aggression and cruelty that is unusual for them, they fight and offend animals.

The hypodynamic form of cerebrasthenic syndrome is characterized by lethargy, fearfulness, skittishness, timidity and indecisiveness, lack of initiative, and increased emotional sensitivity.

Behavioral disorders lead to exhaustion and fatigue over time. With complete preservation of intelligence, children begin to study poorly.

Neurosis-like conditions

Neurosis-like conditions, as consequences of meningitis, are characterized by monotony of manifestations and rigidity of the course.

Young children develop vegetative visceral syndrome, manifested by regurgitation, unstable stools, marbling of the skin, etc. Their sleep is disturbed, it becomes superficial and restless.

Children aged 4 to 7 years old develop obsessive movements, stuttering, night terrors, and enuresis.

Older children develop neurasthenia, sometimes hysteria and obsessive-compulsive neurosis, and vegetative-vascular dystonia.

Headaches are constant. They are provoked by overwork and anxiety. The pain is moderate in intensity, combined with dizziness, pale skin and sweating.

Hypothalamic dysfunction syndrome

Autonomic disorders, as a consequence of meningitis, are sympathetic, parasympathetic and mixed.

Rapid pulse, increased blood pressure, dry and pale skin, chilly legs, dry mouth, periodic increases in body temperature and white dermographism are the main manifestations of sympathicotonia.

Slow pulse, decreased blood pressure, increased salivation, increased intestinal motility, red dermographism are the main manifestations of parasympathicotonia.

Often the same child experiences symptoms of both types of autonomic disorders. The development of neuroendocrine metabolic syndrome is characterized by the development of obesity, edema and delayed puberty. If thermoregulation is disturbed, prolonged low-grade fever, sometimes hypothermia and chill-like hyperkinesis are recorded. With neurotrophic syndrome, baldness or excess hair growth appears in areas of the skin that are not typical for these areas (hypertrichosis), dry skin, and brittle nails. With neuromuscular syndrome, general and muscle weakness and adynamia appear.

Intracranial hypertension syndrome

Hypertension syndrome, as a consequence of meningitis, is manifested by headaches, dizziness and often accompanied by vomiting. Headaches appear in the morning and are paroxysmal in nature. Intracranial hypertension syndrome develops 2 to 6 months after the onset of the disease.

Focal disorders of the central nervous system

Focal disorders of the central nervous system are manifested by central paresis, damage to individual cranial nerves and cerebellar disorders, which respond well to treatment.

3 to 6 months after treatment, epileptiform seizures of various types may develop.

Rice. 11. The photo shows epileptiform seizures in children.

Cerebrasthenic syndrome

Cerebrasthenic syndrome, as a consequence of meningitis, is manifested by general weakness, increased fatigue, weakening of general reactions, decreased memory and dissipation of attention.

Rice. 12. Meningitis often occurs against the background of meningococcemia (meningococcal sepsis).

Signs and symptoms of meningococcal infection in the lungs

When the vessels of the lung tissue are damaged, a specific inflammation develops - meningococcal pneumonia. The disease develops against the background of severe intoxication.

The liquid sweats into the lumen of the alveoli, innervation is disrupted, the level of affinity of hemoglobin for oxygen decreases, respiratory failure and pulmonary edema develop, and the pleura may be affected. Initially, there is a focal lesion, but over time the infection spreads to the entire lobe of the lung. When you cough, a large amount of sputum is produced.

Recovery from meningococcal pneumonia is slow. The patient has been bothered by a cough for a long time, and asthenia develops.

Treatment of meningitis

The mainstay of treatment for meningitis is antibiotics .
With the help of these drugs, it is possible to stop the development of the disease. Therapy is carried out exclusively in the infectious diseases department of the hospital. First of all:

The patient is provided with bed rest and gentle nutrition, as these are important conditions that must be observed for the treatment to be effective.
In addition to antibacterial agents, the treatment of meningitis includes antiviral drugs, and, if necessary, resuscitation measures are performed.
Antihistamines and anti-inflammatory drugs are prescribed to alleviate the patient's condition and relieve symptoms.

The course of treatment for a person of any age with meningitis is 10 days . If there are complications in the form of pus in the cranial cavity, then the treatment time increases. After discharge from the hospital, the patient remains on home treatment for a long time. Some people who have had meningitis need about a year to fully recover.

Signs and symptoms of meningococcal infection in joints

Joint damage due to meningococcal infection is recorded in 5 - 8% of cases. More often one joint is affected, less often two or more. The wrist, elbow and hip joints are usually affected. Initially there is pain and swelling. With delayed treatment, the inflammation becomes purulent, which leads to the development of contractures and ankylosis.

Rice. 14. Arthritis due to meningococcal infection.

Laboratory diagnosis of meningococcal meningitis

In the blood there is a significant increase in the number of leukocytes and neutrophilic granulocytes, and the erythrocyte sedimentation rate.
During a spinal puncture, the cerebrospinal fluid is cloudy, flows out under pressure, and often has a greenish tint. With purulent meningitis, there is a significant increase in cellular elements in the cerebrospinal fluid (pleocytosis), a decrease in the content of sugar and chlorides.
A smear prepared from the cerebrospinal fluid of a patient with meningitis reveals meningococci.

Rice. 13. The photo on the left shows the appearance of cerebrospinal fluid during meningitis. In the photo on the right, meningococci are obtained from the cerebrospinal fluid (bacterioscopy) of a patient with meningitis.

Additional research methods include electroencephalogram (EEG), brain computed tomography (CT), neurosonography (NSG), color Doppler mapping, etc.
If necessary, doctors of different specialties are involved in examining patients - ophthalmologists, otolaryngologists, neurologists.

Rice. 14. An electroencephalogram allows you to detect structural changes in the brain.

Rice. 15. Computed tomography of the brain allows one to detect the presence of hematomas, hydrocephalus and other space-occupying lesions localized in the brain.

Rare forms of meningococcemia

Damage to the paranasal sinuses

Inflammation of the paranasal sinuses occurs with meningococcal nasopharyngitis and with a generalized form of infection.

Urethral lesion

Meningococcal nasopharyngitis can cause specific urethritis in homosexuals during orogenital contact.

Meningococcal iridocyclitis and uveitis

With meningococcal sepsis, the choroid of the eyes can be affected (uveitis). The lesion is often bilateral. Vitreous opacification is noted. It detaches from the retina. In places of peeling, rough adhesions form. Visual acuity decreases. Sometimes secondary glaucoma and cataracts develop.

With inflammation of the ciliary body and iris (iridocyclitis), severe pain appears already on the first day, visual acuity sharply decreases, even leading to blindness. The iris protrudes forward and takes on a rusty tint. Intraocular pressure decreases.

Involvement of all tissues of the eyeball in the inflammatory process (panophthalmitis) can result in complete blindness.

Rice. 15. Meningococcal uveitis (left) and iridocyclitis (right).

What does the rash look like as the process progresses?

If initially the elements of the rash are located singly, do not rise above the surface of the skin and have a bright red color, at the next stages of the disease they change their appearance. Gradually they begin to rise above the skin and acquire clearer outlines.

Over time, small spots begin to fade and, like any erythema, gradually fade to the normal color of the skin. Those areas where a massive fusion of the rash has occurred are unable to recover. They undergo changes of a necrotic nature: they become non-viable, and can turn into an ulcerative-necrotic form.

Such changes can occur within 5-10 days from the onset of the manifest form.

Fulminant form of meningococcemia

The fulminant form of meningococcemia or Waterhouse-Friderichsen syndrome is an acute sepsis accompanied by multiple hemorrhages in the adrenal glands. The disease occurs in 10 - 20% of cases of generalized meningococcal infection and is the most unfavorable form in terms of prognosis. The mortality rate ranges from 80 to 100%.

Signs and symptoms of fulminant meningococcemia

With the disease, multiple extensive hemorrhages into the skin and the rapid development of bacterial shock are noted. With hemorrhages in the adrenal glands, a deficiency of gluco and mineralocorticoids occurs, as a result of which disturbances in the metabolism and function of a number of organs and systems quickly occur in the patient’s body. The developed crisis (acute adrenal insufficiency) proceeds like Addison's disease and often ends in death.

The fulminant form of meningococcemia occurs suddenly. Body temperature rises significantly - up to 40°C, severe headache and nausea appear. The patient becomes lethargic. Large areas of hemorrhage appear on the skin.

Blood pressure drops, tachycardia appears, the pulse becomes thready, breathing quickens, and diuresis decreases. The patient falls into a state of deep sleep (stupor). Coma develops.

Rice. 16. Severe form of meningococcal infection in a child.

Diagnosis of the fulminant form of meningococcemia

In the blood of patients with the fulminant form of meningococcemia, there is a significant increase in leukocytes and residual nitrogen, a decrease in platelets, sodium, chlorine and sugar.

If meningitis develops due to meningococcemia, a spinal puncture is performed.

Emergency care for fulminant meningococcemia

Treatment of Waterhouse-Friderichsen syndrome is primarily aimed at combating corticosteroid deficiency; in parallel, water and electrolyte metabolism is corrected, drugs are used to increase blood pressure and blood sugar, and antibacterial treatment is aimed at fighting infection.

To compensate for the lack of corticosteroids, hydrocortisone and prednisolone are administered.

In order to correct water-electrolyte metabolism, a solution of sodium chloride with ascorbic acid is administered. To increase blood pressure, mesatone or norepinephrine is administered. To support cardiac activity, strophanthin, camphor, and cordiamin are administered.

Rice. 17. The photo shows hemorrhages in the adrenal glands in Waterhouse-Friderichsen syndrome.

Are hemorrhagic rashes dangerous with this disease?

Complicated variants of the pathological process are often diagnosed. Inflammation occurring in the meninges almost always goes away. But if treatment was started at the wrong time or the disease is severe, then this is fraught with the following complications :

delay in the mental development of the child;
mental defeat;
development of a paresis, paralyzed state;
blindness or strabismus;
limitation of auditory perception;
the patient becomes asthenic, inhibited, his memory decreases and he lacks attention.

If you suddenly find such a rash against the background of a high temperature, especially if new elements of the rash appear one by one in a matter of minutes, call an ambulance URGENTLY. Infectious disease doctor E.S. Nekrasova 21st city clinic, Minsk.

Meningitis is a rather dangerous disease. When an infectious process damages the brain, the functioning of many systems throughout the human body is disrupted. If treatment is not started in time, the consequences can be extremely unfavorable. The most dangerous complication remains the death of the patient.

Infectious-toxic shock with meningococcemia

Infectious-toxic shock develops in fulminant forms of meningococcal infection and is its most dangerous complication.

Infectious-toxic shock is based on bacterial intoxication. As a result of the massive death of meningococci, endotoxins are released, which damage blood vessels and lead to paralysis of small vessels. They expand, the blood in the vascular bed is redistributed. A decrease in the volume of circulating blood leads to disruption of microcirculation and a decrease in its perfusion to organs and tissues. Intravascular coagulation syndrome develops. Redox processes are disrupted. The function of vital organs decreases. Blood pressure drops rapidly.

The administration of penicillin leads to massive death of meningococci and the release of endotoxin, which aggravates the development of shock and accelerates the death of the patient. In this case, instead of penicillin, chloramphenicol should be administered. After the patient has recovered from shock, the administration of penicillin can be continued.

The development of infectious shock can be judged by the following signs:

rapid spread of the rash and its appearance on the face and mucous membranes,
decrease in blood pressure, increase in tachycardia and shortness of breath,
rapid increase in disturbance of consciousness,
development of cyanosis and hyperhidrosis,
a decrease in leukocytes and neutrophils in the peripheral blood, the appearance of eosinophilic granulocytes, a slowdown in ESR,
decreased protein, severe acidosis, decreased blood sugar.

The body temperature of patients rapidly drops to normal levels. Excitement is noted. Urine stops coming out. Prostration develops. Convulsions appear. The patient's death occurs.

Rice. 18. The photo shows meningococcal infection in an adult.

First aid

Since a hemorrhagic rash occurs when blood capillaries rupture, the first action upon detection should be to limit the child’s mobility and maintain bed rest until the doctor arrives.

Important! If a rash and symptoms similar to meningitis appear, you should immediately call an ambulance and take the patient to the hospital.

Only a doctor, after a general examination and examination of tests, can make a diagnosis and prescribe treatment. Meningitis is not only a severe illness for the patient himself, but also dangerous for others .