Pre-hospital stage: emergency measures
The primary goal of the ambulance team is the emergency hospitalization of the patient to a specialized infectious disease department. Due to the severity of the condition, which is accompanied by pronounced intoxication and general cerebral symptoms, therapy must be initiated immediately, even during transport.
The main drug for etiotropic treatment at this stage is ceftriaxone. Its use is justified by the fact that until test results are obtained, the etiology of meningitis remains unclarified, and the pathogen may turn out to be flora resistant to penicillins. However, in cases of clear suspicion of meningococcemia, especially when combined with meningeal signs, parenteral administration of penicillin is permitted.
Simultaneously with the first dose of the antibiotic, pathogenetic therapy is initiated, which includes:
- Parenteral detoxification;
- Intravenous administration of glucocorticoids;
- Use of diuretics (e.g., Lasix);
- Desensitizing and oxygen therapy.
Throughout the entire pre-hospital stage, continuous monitoring of vital signs is required for the early detection of infectious-toxic shock and cerebral edema/swelling.
Clinical markers for initiating intensive care
Suspicion of a generalized form of infection should arise when a combination of characteristic clinical signs is present, requiring immediate intervention.
Key symptoms include:
- Acute onset: sudden rise in temperature to febrile levels (39.0–40.0°C), chills, severe weakness.
- General cerebral syndrome: intense headache, often localized in the occipital region, recurrent dry (empty) vomiting that does not bring relief to the patient.
- Meningeal signs: nuchal rigidity, positive Brudzinski's signs, hyperesthesia (including pronounced photophobia).
- Hemorrhagic exanthema: petechial rash on unaltered skin background, which does not disappear upon pressure. Elements may appear within just a few hours from the onset of fever.
The presence of skin pallor, cold hands and feet, as well as tachycardia (e.g., pulse 120 bpm with normal or decreased blood pressure) indicates the development of a shock state and requires urgent infusion anti-shock therapy.
Hospital stage: diagnostics and management
In the hospital, treatment continues according to the principles of empirical therapy until laboratory data are obtained. A critically important rule: the collection of blood and cerebrospinal fluid (CSF) for bacteriological examination must be performed before the start of regular antibacterial therapy.
CSF examination in purulent meningitis typically reveals intracranial hypertension, neutrophil pleocytosis, increased protein levels, and a sharply positive Pandy's reaction.
To confirm the diagnosis, specific diagnostics are prescribed:
- PCR testing;
- Latex agglutination test;
- Countercurrent immunoelectrophoresis (CIE).
Simultaneously, differential diagnosis with secondary purulent meningitis is carried out, which requires examination of the ENT organs, urinary system, and chest organs. In the absence of positive dynamics, EEG, MRI, or CT of the brain are prescribed, along with a consultation with a neurologist.
Prevention and anti-epidemic measures
If the diagnosis is confirmed, it is necessary to promptly manage the focus of infection. The physician identifies all contacts (primarily family members) and organizes chemoprophylaxis.
Daily medical observation is established for contacts for a period of 10 days. It includes mandatory thermometry, examination of the skin and nasopharyngeal mucosa. If contacts develop symptoms of acute nasopharyngitis, they are referred for bacteriological examination, and if clinical or epidemiological indications are present, they are hospitalized.
Briefly: answers to topical questions
What symptoms and reflexes are included in the concept of "meningeal signs" in meningococcal infection?
Meningeal syndrome in meningococcal meningitis includes the following groups of manifestations:
- Hyperesthesia: photophobia, hyperacusis, increased tactile sensitivity; exposure to external stimuli intensifies the headache.
- Reactive pain symptoms: increased headache, dizziness, and vomiting with sharp head tilting; soreness upon pressure on the eyeballs through closed eyelids; soreness upon palpation of the exit points of the trigeminal and occipital nerves; Mendel's sign.
- Meningeal symptoms that need to be checked: nuchal rigidity, Kernig's sign, upper and lower Brudzinski's signs.
With which diseases is it necessary to perform a differential diagnosis of meningococcal meningitis?
Differential diagnosis of meningococcal meningitis is carried out with the following conditions:
- Purulent and serous meningitis of other etiologies: pneumococci, Haemophilus influenzae, streptococci, staphylococci, Klebsiella, Escherichia, Salmonella, Listeria, Leptospira, spirochetes, Mycobacterium tuberculosis, Coxsackie viruses, ECHO, mumps virus, etc.
- Meningoencephalitis of another etiology.
- Meningism.
- Brain abscesses.
- Subarachnoid hemorrhage.
What antibacterial drugs are used for chemoprophylaxis of contacts in a focus of meningococcal infection?
Systemic antibacterial drugs in tablet form are used for chemoprophylaxis of contacts in a focus of meningococcal infection.
Used administration regimens:
- Ciprofloxacin — prescribed at a dosage of 500 mg orally once.
- Rifampicin — prescribed at a dosage of 600 mg orally every 12 hours for 2 days.
What clinical forms of generalized meningococcal infection are distinguished in the classification?
The clinical forms of generalized meningococcal infection indicated in the sources include:
- Meningococcal meningitis.
- Meningococcemia: acute, chronic, unspecified.
- Hyperacute meningococcal sepsis.
- Meningococcal meningoencephalitis.
- Mixed form: meningococcemia + meningitis; an example of a mixed form "meningococcal meningoencephalitis + meningococcemia" is also given.
For rapid risk assessment, remember: the combination of acute fever, recurrent dry (empty) vomiting, and a rash that does not fade upon pressure is a direct signal for immediate anti-shock and antibacterial therapy.
Class and exam questions
Which antibiotic is used at the pre-hospital stage?
The drug of choice is ceftriaxone, since the etiology of meningitis is initially unclarified, and the pathogen may be flora insensitive to penicillins.
When is it necessary to initiate pathogenetic treatment?
Pathogenetic therapy, including detoxification and glucocorticoid administration, is initiated immediately, simultaneously with the first dose of antibiotic.
What actions should be taken if infectious-toxic shock is suspected?
Infusion anti-shock therapy must be started immediately without waiting for hospital admission.
What else to study on this topic
- Clinical and laboratory criteria for meningococcemia
- Differential diagnosis of meningeal syndrome
- Features of the clinical course of mixed forms of meningococcal infection
- Interpretation of cerebrospinal fluid analysis in purulent meningitis
- Focal neurological symptoms in meningoencephalitis
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