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9МЕДИЦИНСКИЕ НАУКИ
ETIOLOGICAL STRUCTURE OF MENINGITIS AND MENINGOENCEPHALITIS IN
CHILDREN
Dos. KONUL ELEMDAR JAFAROVA
Azerbaijan Medical University, Department of Infectious Diseases ORCÎD- 0000-0002-1159-1548
Dos. SHAMSA MAMMAD RASHIDOVA
Azerbaijan Medical University, Department of Infectious Diseases
Dos. SADRADDIN ABDULLA ATAKISHIZADE
Azerbaijan Medical University, Department of Infectious Diseases
Ass. GOSHGAR ISMAYIL ISMAYILOV Azerbaijan Medical University, Department of Children Diseases - 2 ORCÎD - 0000-0002-9191-2747
Purulent bacterial meningitis (PBM) is an inflammatory process that occurs in the pia mater of the brain when microorganisms (bacteria) penetrate into it - meningococci, pneumococci, Haemophilus influenzae, etc.
In bacterial meningitis, delayed presentation to hospital increase the risk of subdural effusion, hydrocephalus, hearing impairment and seizure disorder [1].
Children with hearing loss and / or intellectual disability will need neurodevelopmental follow up and support for speech, language and social development [2].
All age categories are susceptible to PBM disease, mostly people who are not vaccinated against the causative agents of this infection. Most often, purulent meningitis develops in children and the elderly. The disease often occurs against the background of a weakened state of the immune system. The penetration of pathogens of purulent meningitis through the blood-brain barrier is facilitated by a weakened state of the body's immune system, which can be caused by frequent acute respiratory viral infections, stress, physical overload, and a sharp change in climate [1].
The etiology of lesions of the central nervous system is diverse. Timely etiological diagnosis is important for successful treatment and prevention of complications of meningitis.
As noted earlier, the incidence of acute meningitis was characterized by periodic ups and downs. . According to these peaks, there was an increase in the incidence of both serous and purulent meningitis.
Key words: meningitis, etiological structure, epidemiological features, bacterial meningitis, etiological agents
In the warm season, in addition to the expected rise in the number of meningitis of enteroviral etiology, there are meningitis with a variety of etiologies: staphylostreptococcal, zoonotic (yersinia, salmonella), meningococcal. As you know, strepto staphylococci enter the human normal flora and colonize the mucous membranes and skin. The development of meningitis is more often due to the endogenous route of infection when pathogens are introduced from the places of colonization through the bloodstream into the central nervous system, similar to the pathogenesis of the development of generalized forms of meningococcal infection. In zoonotic infections, meningitis is a secondary focal form of the disease when the infection is generalized [4,5].
The aim - to analyze the etiological structure of infectious lesions of the nervous system in children.
Methods. The indicators of the etiological structure in sick children in 2014-2019 were studied. There was no statistical difference in the number of patients with purulent meningoencephalitis and meningoxemic pathology (p>0.05; Wemp=28.5, p=0.085).
Results. Averages for 2014-2019 were: purulent meningoencephalitis - 3.67±1.63; meningoxemia - 2.40±1.14.
Relative indicators for 2014-2019: in 2014, purulent meningoencephalitis - 14.0%; meningoxemia - 4.7%.
In 2015 - patients with purulent meningoencephalitis - 9.3%; patients with meningoxemia -
9.3%.
In 2016, patients with purulent meningoencephalitis - 7.0%; meningoxemic patients - 4.7%.
In 2017, patients; with purulent meningoencephalitis - 9.3%; with meningoxemia - 2.3%.
In 2018 - with purulent meningoencephalitis - 2.3% of patients.
In 2019 - patients; purulent meningoencephalitis - 9.3%; with meningoxemia - 7.0% of patients.
purulent meningoencephalitis - y=3.67-1.1x;
meningoxemia - y=2-0.53x.
Bacterial meningitis as a monoinfection caused by E. coli has been diagnosed among patients of all age groups, including children under the age of 1 year. E. coli was additionally isolated from the cerebrospinal fluid of patients with meningitis in association with other microorganisms: in one child with C. albicans (the age of the patient is up to 1 year), in two patients together with Proteus and S. aureus. S. aureus as an etiological agent was isolated from the cerebrospinal fluid of eight patients with meningitis in almost all age groups, except for children under one year old. This microorganism was also a rather active agent of mixed forms of infections in association with C. albicans, E. coli + Proteus and Actinomyces odontoliticus.
The main features of bacterial meningitis are life-threatening clinical manifestations, unpredictability of the outcome of the disease, as well as high rates of disability and mortality, which once again emphasizes their significant place in the general list of infections of the central nervous system. Under these conditions, improving the rapid clinical diagnosis of this condition, the timely performance of lumbar puncture and the correct decoding of the etiological agent is the only way to help most patients with this condition. The clinical picture of purulent meningitis consists of intoxication, cerebral, meningeal syndromes and changes in the cerebrospinal fluid. The moderate course is characterized by an acute onset, with severe chills and an increase in body temperature up to 38-39C, with a constant type of temperature curve. The manifestations of severe general intoxication progress rapidly - severe general weakness, apathy or anxiety, loss of appetite, cyanosis of the nasolabial triangle [6].
The manifestations of cerebral symptoms include headache, which, with meningitis, reaches a particular intensity and severity. It is diffuse in nature, less often localized in the frontotemporal or occipital region. Its intensity increases with developing hydrocephalus, leading to an increase in intracranial pressure, and as the inflammatory process progresses. Often, headache is accompanied by vomiting in the first days of the disease, more often with a change in body position. Vomiting is central in nature and occurs due to irritation of the vomiting center. It does not bring relief and is not associated with food intake, is intense ("fountain") and appears suddenly - without preceding nausea. There is an increased sensitivity (hyperesthesia) to all types of external stimuli, including light (photophobia) and sound (hyperacusia).
The leading place in the symptom complex of the disease is occupied by meningeal symptoms, which serve as an indication for the study of cerebrospinal fluid [6].
Elucidation of the etiological origin is a fundamental factor for conducting a reliable clinical diagnosis of meningococcal infection and purulent bacterial meningitis, identifying prognostic criteria for epidemiological distress, prescribing correct antibacterial treatment, and developing preventive measures.
Thus, within the studied years, the statistical indicators were not large relative to meningitis in our hospital.
REFERENCES
1.Teixeira D.C., Diniz L.M.O., Guimaraes N.S. et al. Risk factors associated with the outcomes of pediatric bacterial meningitis: A systematic review // J. Pediatr., 2020, 96, p.159-167.
2.Kostenniemi U.J., Bazan A., Karlsson L. et al. Psychiatric Disabilities and Other Long-term Consequences of Childhood Bacterial Meningitis // Pediatr. Infect. Dis. J., 2020;40:26-31
3. Alpine A., Sadarangani M. Meningitis vaccines in children // Curr. Opin. Infect. Dis., 2019;32:510-516
4.Никольская М.В., Курмаева Д.Ю., Айтматова М.А. и др. Этиологическая структура и эпидемиологические особенности менингитов у детей // Вестник ПензГУ.2021.№1(33),с.50-53
5. Atkinson W., Wolfe S., Hamborsky J., McIntyre L. CDC. Meningococcal disease. In: Epidemiology and Prevention of Vaccine-preventable Diseases. (The Pink Book). Washington: Public Health Foundation, 2015; 231-245
6. McIntyre P., O'Brien K., Greenwood B., van de Beek D. Effect of vaccines on bacterial meningitis worldwide. Lancet. 2012; 380 (9854): 1703-1711
