Meningococcal infection
Meningococcal infection is a rare disease, and not every GP in Bulgaria encounters even one such sick person during his entire practice.
The disease is an anthropozoonosis transmitted by airborne droplets and is characterized by a wide range of clinical manifestations – from meningococcal carriage to meningitis and severe meningococcal sepsis, characterized by a fulminant course.
What are the causes?
The cause of meningococcal infection is the gram-negative diplococcus Neisseria meningitidis highly sensitive to environmental factors – it dies at differences in temperature, humidity, intensity of solar radiation, capricious to cultivation in laboratory conditions. Outside the body, it retains its viability for no more than 30 minutes.
13 serotypes of the causative agent are known. The most epidemiologically important for Bulgaria are serotypes A, B, C, but relatively often infections with Y are also found.
When blood or cerebrospinal fluid is placed directly under a microscope, the bacterium is found intracellularly and extracellularly and resembles coffee beans in shape. Lipopolysaccharide responsible for the endoxin-like effect in meningococcal sepsis is observed in the cell envelope of the pathogen.
Epidemiology
In most European countries, including Bulgaria, the prevalence of meningococcal infection is 1-3 cases per 100,000 population, it occurs at any age, however 70-80% of them are children under 3 years of age.
The most likely is the development of hypertoxic /hyperacute/ forms of the infection during the first 3 years of children’s lives, especially in the first year of life.
It is characteristic that the incidence rate increases every 10-20 years, which is associated with changes in the bacterium causing meningococcal infection and a change in the immunological structure of the population / an increase in the number of the susceptible part of the population due to constant childbirth of children and lowering the immunity of the elderly/.
There is also a place for the seasonal increase in the frequency of morbidity – March, April, May, although patients with this infection are registered throughout the year.
The source of the disease is the sick or the bacteria carriers. The transmission mechanism is air-droplet. The most contagious are patients with catarrhal symptoms from the side of the nasopharynx.
Healthy carriers are also of epidemiological importance, as their number exceeds the number of sick by hundreds of times. It is known that a harbinger of a further increase in morbidity is a further increase in the number of meningococcal carriers.
In nurseries and kindergartens and in general in children’s collectives, prolonged contact in the premises, especially in the bedrooms, contributes to the meningococcal infection.
The susceptibility to this bacterium, that is, it can easily cause an infection, in early childhood is quite high. But the typical thing is that the typical clinical picture is observed in only 0.5% of those infected.
Family predisposition to meningococcal infection is extremely rare.
In these families, cases of meningococcemia and meningitis were observed in different children at different times /with an interval of several years/, and also repeated cases of diseases in one of these children.
Child mortality in the first year of life is highest.
The main cause is hyperacute meningococcal sepsis with the development of infectious-toxic shock, as well as severe purulent meningitis, complicated cerebral edema.
Modern methods of diagnosis, timeliness and correctness of the started treatment have the greatest influence on the outcome of the disease.
Treatment of meningococcal infection
It should be started immediately. First aid to the patient must be provided by the doctor who first suspected or diagnosed meningococcemia.
The patient should be administered, preferably internally, chloramphenicol succinate and prednisolone.
