Meningitis in Children - I.V. Bohadelnikov 2005

Secondary Purulent Meningitis in Children. General Information
Escherichia coli Meningitis

Escherichia coli meningitis is a secondary Purulent meningitis that occurs primarily in infants or babies in the first months of Life as a complication of generalized (septic) colibacillosis. It is characterized by a severe clinical course, marked intoxication, cerebral symptoms, meningeal syndrome, and high mortality.

Etiology. The causative agents of the disease are E. coli, which are straight, rod-shaped, Gram-negative Bacteria measuring 1.1–1.5 by 2.0–6.0 µm; most strains possess a capsule. Among Escherichia strains, there are both motile and non-motile forms prone to polymorphism. Due to the presence of fibrils containing fimbriae and pili, E. coli possess The ability to adhere and subsequently colonize. They grow on ordinary nutrient media and are facultative anaerobes. Differentiation between pathogenic and non-pathogenic strains of Escherichia, which have a complex antigenic Structure, is based on differences in The structure of surface Antigens: lipopolysaccharide (O), flagellar (H), and capsular (K). Currently, more than 160 serotypes are known. The heterogeneity of Escherichia and the variety of clinical symptoms have led to the division of pathogenic E. coli into 5 groups: enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroinvasive (EIEC), enterohemorrhagic (EHEC), and enteroaggregative (EAEC), of which meningitis is caused by strains of the first group—EPEC.

Epidemiology. The transmission mechanism of colibacillosis is fecal-oral. The infection is spread through food, while in closed settings, contact transmission can be of great importance. In newborns, an endogenous route of infection with subsequent hematogenous dissemination is possible. E. coli meningitis is more frequently caused by pathogenic E. coli serotypes: O1, O6, O7, O16, O18, O83, and D01. Predisposing factors include Birth Trauma to the HEAD, prematurity, preceding infectious or somatic diseases, and pre- or intrapartum maternal infection. The main risk group for E. coli meningitis consists of newborns, more often boys, with low birth weight (under 2,500 g). However, it is not always possible to determine the route of infection when meningitis develops. Most commonly, meningitis develops against the Background of an intestinal infection, but an umbilical route of infection with hematogenous spread is also possible. In any case, E. coli meningitis is a complication of bacteremia and develops in 10–40% of infants suffering from colibacillosis.

Pathogenesis. The infection enters the body through the Oral Cavity. EPEC reach the Small Intestine with almost no loss, where colonization and reproduction occur On the surface of enterocytes. The most cytotoxic among them are capable of being transported by phagosome-like vacuoles through epithelial Cells into the underlying tissue and further into the bloodstream, leading to transient bacteremia and Sepsis (V.I. Pokrovsky, 1989). This process is facilitated not only by the cytotoxicity of E. coli, but also by the Anatomical and physiological immaturity of the gastrointestinal tract, increased permeability of cellular and vascular membranes, and the Blood-Brain barrier (BBB). Endotoxins released during the death of E. coli, their metabolic products, and BIOLOGICALLY ACTIVE SUBSTANCES enhance this process and enable the penetration of EPEC across the BBB, resulting in damage to the Meninges and brain tissue.

Clinical manifestations. The onset of meningitis is acute, accompanied by The Development of infectious-toxic syndrome: Temperature elevation up to 39°–40°C, lethargy, anorexia, vomiting, and restlessness. The Skin is pale, sometimes with a yellowish tinge, dry to the Touch, with a pronounced mottled pattern and decreased tissue turgor. Against the background of increasing intoxication, attacks of clonic-tonic seizures appear, muscular hypotonia is rapidly replaced by limb hypertonia, meningeal signs are detected, and Reflexes are depressed. Respiratory distress syndrome may be pronounced. Tachycardia, muffled Heart sounds, and oliguria are characteristic. Enlargement of The Liver and Spleen is observed. In cases where meningitis develops in patients with symptoms of enteritis and exicosis without adequate fluid replacement, CEREBROSPINAL FLUID (CSF) hypotensive syndrome is revealed.

The clinical course of E. coli meningitis is severe, with high mortality: in infants born from physiological deliveries, it reaches 12%, whereas in those belonging to the risk group, it is up to 35%. In 20–50% of survivors of E. coli meningitis, persistent neurological disorders were observed.

Main diagnostic criteria for E. coli meningitis:

1. Epidemiological history: meningitis develops against the background of E. coli infection, predominantly affecting infants and children in the first months of life with an unfavorable premorbid background and the presence of pre- or intrapartum infection in the mother.

2. The onset of meningitis is acute, with the development of pronounced infectious-toxic syndrome followed by The addition of meningeal syndrome.

3. The course of meningitis may be accompanied by CSF hypotension.

4. The presence of other purulent foci of infection—otitis, Pneumonia, enteritis, Pyelonephritis, etc.—is characteristic.

5. Bacteriological isolation of various serotypes of enteropathogenic E. coli from the CSF, either isolated or in association with other pathogens, confirms the etiological Diagnosis.

Laboratory Diagnostics. Complete blood count. Peripheral blood reveals leukocytosis, neutrophilia with a left shift, and an elevated ESR.

CSF examination. Moderate neutrophilic pleocytosis, high protein content, and decreased glucose concentration are found in the CSF.

Bacteriological examination. A distinctive feature of isolating the pathogen is that the bacteriological analysis is based on determining antigenic properties rather than studying biochemical characteristics. Blood, CSF, feces, and umbilical discharge are subjected to bacteriological examination. Inoculation is performed on selective-differential media (Ploskirev, Levin, Endo, As الصح-Lieberman Agar).

BACTERIOLOGICAL EXAMINATION OF the CSF isolates pathogenic E. coli resistant to most Antibiotics. In addition, associations of E. coli with other pathogens—staphylococcus, mycoplasma, and various serotypes of the Influenza virus—are frequently detected in the CSF.