Meningitis in Children - I.V. Bohadelnikov 2005

Secondary purulent meningitis in children. General data
Meningitis caused by *Pseudomonas aeruginosa* (pseudomonal meningitis)

Pseudomonal meningitis is a Purulent meningitis representing a manifestation of a severe generalized infection caused by Pseudomonas aeruginosa, characterized by pronounced symptoms of intoxication and frequent involvement of the Brain parenchyma.

Etiology. The CAUSATIVE AGENT OF the disease is a Gram-negative bacillus, Pseudomonas aeruginosa, belonging to the family Pseudomonadaceae, genus Pseudomonas. It measures 1-3 by 0.5-1 µm, is motile, possesses 1 or 2 polar flagella, and synthesizes a starch-like substance. It grows in a wide Temperature range from 4 to 42⁰С, can persist in the environment for a long time, and withstand elevated body temperature. It is an obligate aerobe, exhibits highly pronounced proteolytic activity, and synthesizes hyaluronidase. The ability to synthesize starch-like substances in the form of mucus allows it to be considered a pathogenicity factor. The microbe is capable of synthesizing A number of pigments: the Water-soluble pigment pyocyanin and the green pigment fluorescein, which contribute to the green coloration of the material, pyorubin (red), pyomelanin (black-brown), and L-oxyphenazine (yellow). The toxicity of the microbe is due to endotoxins, cytotoxins, hemolysins, and other metabolic products, among which the most important are the enterotoxic factor, permeability factor, neuraminidase, neutral protease, Elastase, and collagenase. Diagnostically significant Antigens of Pseudomonas aeruginosa are the somatic O-antigen and the flagellar H-antigen. Pseudomonas exhibits high resistance to most Antibiotics, mediated by R-Plasmids, which explains the particularly severe clinical course of Meningitis caused by Pseudomonas aeruginosa.

Main diagnostic criteria for meningitis caused by Pseudomonas aeruginosa:

1. Epidemiological history: prior prolonged septicemia, hematogenous pathway of spread, occurrence in children of all ages, but more frequently in premature and early-age infants.

2. Onset of meningitis is acute or subacute, with fever and pronounced meningeal symptoms.

3. Frequent involvement of the brain parenchyma with The Development of severe meningoencephalitis (with purulent melting of the cerebral parenchyma and formation of pyocephalus).

4. Frequently presents with a hemorrhagic rash on the Skin of the abdomen, lateral surfaces of the chest, and lower extremities.

5. Frequent development of purulent lesions of the skin, respiratory Organs, Skeletal System, and Urinary System.

6. Upon lumbar puncture, the CSF is purulent, creamy in consistency, with blue-green flakes, high protein content, and neutrophilic pleocytosis.

7. Bacteriological isolation of Pseudomonas aeruginosa from the CSF, Blood, and discharge from septic foci, resistant to most antibiotics, confirms the etiological Diagnosis.

Laboratory Diagnostics. General blood count. Peripheral blood reveals leukocytosis, neutrophilia, a shift of the formula to the left (band forms), and an elevated ESR.

CEREBROSPINAL FLUID analysis. The CSF is typically purulent, often creamy in consistency, with blue-green flakes, high protein content, pleocytosis predominantly due to neutrophils, and decreased glucose levels.

Bacteriological examination. To identify the pathogen, patient samples (blood, urine, feces, CSF, pus) are inoculated onto meat-peptone Agar, blood agar, and Endo agar. Bacterioscopy is used to search for Gram-negative bacilli, and tests for cytochrome oxidase and catalase synthesized by Pseudomonas are performed.