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Острый бактериальный менингит. Патогенез и профилактика.

Acute bacterial meningitis. Pathogenesis and Prevention.

Bacterial meningitis can cause permanent brain damage and even death. Important is the time of diagnosis. If there is at least the minimum suspicion of this desease, immediately carry out a lumbar puncture with a view to confirm or exclude it, also it will help identify  the causative microorganism. Last usually specify, starting from the patient’s age, the fact of being in endemic areas,  find out his vaccination and immune status.

Pathogenesis

Most pathogens of bacterial meningitis penetrate into the cerebrospinal fluid through the colonization of the nasopharynx or hematogenically – through the vascular plexus in the brain parenchyma and shell. Venous thrombosis facilitates retrograde dissemination of infection. This occurs when the integrity of the dura mater is broken as a result of the fracture of the skull base, recent neurosurgery, epidural corticosteroid injections or anesthesia or when foreign bodies are present – cochlear implants, ventriculoperitoneal shunts, deep brain stimulators. In this situation, meningitis is caused by micro-organisms that are part of the microflora of the skin.

Typically referred to as meningitis and inflammation of the meninges (including soft and arachnoid), this conditions also associated with brain inflammation, its secondary effects as edema and venous thrombosis leading to blockage of pathways cerebrospinal fluid, this leads to hydrocephalus, intracranial hypertension and coma.

Prevention

Vaccination programs against common pathogens (Haemophilus influenzae and meningococcus) in newborns began to spread further in the 1990s, in 2000 additionally become to vaccinate against the pneumococcus. For example, in USA, this led to a clear reduction in the frequency of meningitis. Treatment of infected pregnant women before birth can prevent neonatal meningitis caused by streptococcus group B. The use of supportive antibiotic therapy and prevention of food poisoning have substantially reduced the frequency meningitis in newborns pathogenes of which name Listeria monocytogenes.

The presence of a possible source of infection, such as pneumonia, sinusitis, mastoiditis, dental interventions in recent history, helps to identify the causative pathogen.

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