Meningococcal infection in children

Meningococcal infection is an acute infectious disease with clinical manifestations from nasopharyngitis and asymptomatic carriage to generalized forms - purulent meningitis, meningoencephalitis and meningo-coccemia with the defeat of various organs and systems.

ICD-10 code

• A39.0 Meningococcal meningitis.
• A39.1 Waterhouse-Frideriksen syndrome (meningococcal hemorrhagic adrenalitis, meningococcal adrenal syndrome).
• A39.2 Acute meningococcemia.
• A39.3 Chronic meningococcemia.
• A39.4 Meningococcemia, unspecified (meningococcal bacteremia).
• A39.5 Meningococcal heart disease (meningococcal carditis, endocarditis, myocarditis, pericarditis).
• A39.8 Other meningococcal infections (meningococcal arthritis, conjunctivitis, encephalitis, optic neuritis, postmenococcal arthritis).
• A39.9 Meningococcal infection, unspecified (meningococcal disease).

Epidemiology

Epidemiology of meningococcal infection

The source of infection are sick and bacterial carriers. The patient is most contagious at the onset of the disease, especially when there are catarrhal phenomena in the nasopharynx. Healthy carriers without acute inflammatory phenomena of the nasopharynx are less dangerous, the frequency of carriage exceeds the incidence of diseases 1000 times or more.

Infection is transmitted by airborne (aerosol). Susceptibility is low. The contagious index is 10-15%. The family predisposition to meningococcal infection is traced. Periodic morbidity increases are noted every 8-30 years, which is usually explained by a change in the pathogen (most of the major epidemics were associated with meningococcal group A, in recent years, the incidence of morbidity is often due to meningococcal groups B and C). A precursor of the rise in morbidity is the increase in the number of carriers of meningococci.

The incidence of morbidity falls on February-May; 70-80% of the total incidence falls on children under the age of 14, and among them the greatest number of cases are children under the age of 5 years. Children of the first 3 months of life are seldom ill. Cases of the disease are also described in the period of the newborn. Perhaps intrauterine infection. 

[1], [2], [3], [4], [5], [6]

Causes of the meningococcal infection

Causes of meningococcal infection

The causative agent is meningococcus, from the genus Neisseria - Neisseria meningitidis, gram-negative diplococcus has endotoxin and an allergic substance. Serological properties of individual strains of meningococcus are not homogeneous. According to the agglutination reaction, meningococci are divided into serogroups N, X, Y and Z, 29E and W135.

The most virulent strains of meningococcus are from serogroups A, which are particularly invasive. The ability of meningococci to form L-forms, which can cause a prolonged course of meningococcal meningitis, is proven.

Causes and pathogenesis of meningococcal infection

[7], [8], [9], [10], [11], [12]

Symptoms of the meningococcal infection

Symptoms of meningococcal infection

The incubation period is from 2-4 to 10 days.

Acute nasopharyngitis is the most common form of the disease, accounting for up to 80% of all cases of meningococcal infection. The disease begins acutely, more often with an increase in body temperature to 37.5-38.0 ° C. The child complains of a headache, sometimes dizziness, sore throat, pain when swallowing, stuffiness of the nose. They note lethargy, adynamy, pallor. When examining the pharynx, hyperemia and swelling of the posterior pharyngeal wall are revealed, its granularity is hyperplasia of the lymphoid follicles, swelling of the lateral ridges. There may be a small amount of mucus on the back of the pharynx.

Often, the disease occurs at normal body temperature, a satisfactory general condition and with very weak catarrhal phenomena in the nasopharynx. In peripheral blood, sometimes a moderate neutrophilic leukocytosis is noted. In half the cases, the picture of the blood does not change.

Symptoms of meningococcal infection

Forms

Classification of meningococcal infection

There are the following forms:

• localized form - acute naeopharyngitis;
• generalized forms - meningococcemia, meningitis;
• mixed form - meningitis in combination with meningococcemia;
• rare forms - meningococcal endocarditis, meningococcal pneumonia, meningococcal iridocyclitis, etc.

[13], [14], [15], [16], [17], [18], [19], [20]

Diagnostics of the meningococcal infection

Diagnosis of meningococcal infection

In typical cases, there is no difficulty. Meningococcal infection is characterized by an acute onset, high body temperature, headache, vomiting, hyperesthesia, symptoms of irritation of the meninges, hemorrhagic stellate rash.

Crucial importance in the diagnosis of meningococcal meningitis has a spinal puncture. However, the liquid may be clear or slightly opalescent, pleocytosis ranging from 50 to 200 cells with a predominance of lymphocytes. These are the so-called serous forms of meningococcal meningitis, they usually occur with early treatment. In these cases, antibiotic therapy cuts off the process even at the stage of serous inflammation.

Diagnosis of meningococcal infection

[21], [22], [23], [24], [25], [26]

Treatment of the meningococcal infection

Treatment of meningococcal infection

All patients with meningococcal infection or suspected of it are subject to mandatory and immediate admission to a specialized department or diagnostic box. Carry out complex treatment taking into account the severity of the disease.

In the generalized form of meningococcal infection, penicillin therapy with massive doses is still effective. Assign benzylpenicillin potassium salt intramuscularly from the calculation of 200 000-300 000 units / kg per day. Children under the age of 3-6 months dose is 300 000-400 000 units / kg per day. The daily dose is given in equal parts every 4 hours without a night break. In children of the first 3 months of life, it is recommended that the intervals be shortened to 3 hours.

Treatment of meningococcal infection

Prevention

Prevention of meningococcal infection

In the system of preventive measures, the early isolation of the patient or carrier is crucial. Patients with meningococcemia and purulent meningitis immediately hospitalized. About each case of the disease an emergency notification is sent to the SES. In the teams where the cases are diagnosed, they do not accept new persons for 10 days and prohibit the transfer of children from the group to the group. Bacteriological examination of contact persons is carried out twice with an interval of 3 to 7 days.

Hospitalization of patients with nasopharyngitis conducts according to clinical and epidemiological indications. Such patients are treated with levomycetin for 5 days. If a patient is not hospitalized with nasopharyngitis, then those who come into contact with him are prevented from entering pre-school and other closed institutions before receiving a negative bacteriological examination of mucus from the nasopharynx.

How is meningococcal infection prevented?

Forecast

Forecast

With a timely begun treatment, the prognosis for meningococcal infection is favorable. However, even now, the lethality remains high and averages about 5%. The prognosis depends on the age of the child and the form of the disease. The smaller the age of the child, the higher the lethality. The prognosis worsens with meningococcal meningoencephalitis.

[27], [28], [29]