Meningitis in Children - I.V. Bohadelnikov 2005

Introduction

Every year, more than 52 million people die worldwide, 17 million of them from infectious diseases—a population equivalent to a medium-sized European country (Markin et al., 1999). Central Nervous system (CNS) disorders caused by Bacteria, Viruses, Protozoa, and other pathogens are among the most frequently observed causes of death. In Ukraine, 350 to 800 children die annually from infectious diseases, 25-30% of whom suffer from meningococcal infection; the mortality rate for this nosological form remains unacceptably high, ranging from 12.0% to 22.0%. In 2000, 888 children in Ukraine fell ill with meningococcal infection, and 100 of them died. Even more striking is the fact that between 1997 and 1999, among children who died from viral or bacterial CNS infections, there was a discrepancy between the clinical and post-mortem diagnoses in 46% of cases (Moiseenko et al., 2001). In other words, the wrong disease was treated, and therefore Treatment was incorrect. There may be various explanations for this: sometimes necessary medications were not at hand, there was no fuel for ambulances, or the electricity was cut off. However, this does not change the reality of what occurred. By comparison, in recent years, the mortality rate from meningococcal infection—including among infants—has been zero in Scandinavian countries, Canada, and several other developed nations. It is worth emphasizing that the reported mortality figures in Ukraine refer to meningococcal infection, which is the most readily identifiable infection. In typical cases—accounting for 75-80% of all meningitis cases—the Diagnosis can be made from a distance upon identifying the characteristic manifestations of the disease: acute onset, pronounced symptoms of intoxication, and a hemorrhagic, stellate rash with central necrosis, which is typical of this pathology. If we face such outcomes with meningococcal infection, it is terrifying to contemplate the consequences when the CNS is affected by pneumococcus, Haemophilus influenzae, staphylococcus, streptococcus, listeria, protozoa, Fungi, and other pathogens.

In view of the urgency and Current state of the problem, we present a monograph dedicated to purulent and serous meningitides. The book primarily covers those nosological forms of meningitis that are most frequently encountered in Ukraine.

Evaluating the current situation once again, and considering the consequences of certain neuroinfections in children, as well as the high percentage of discrepancies between clinical and post-mortem diagnoses (46%, and that is only among documented cases; anyone who has ever stood at the autopsy table knows what I mean), one cannot help but conclude that appeals and other democratic Methods have long since exhausted themselves. Only a bureaucratic approach can help resolve this situation. The idea of using this method is not new, especially given our history, but today it is undoubtedly relevant to a whole range of medical issues (Rebyonok, 2001), including neuroinfections in children. However, this falls within the purview of administrative bodies, primarily the Ministry of Health of Ukraine.

Meningitis in children has always been a subject of close scrutiny for scientists and physicians. This is due not only to its incidence rate, severe clinical course, and high percentage of persistent CNS sequelae, but also to the fact that meningitis, both in the past and today, fundamentally raises the question of life and death.

The work of domestic and foreign researchers has significantly expanded our understanding of the Etiology, Epidemiology, and Pathogenesis of meningitis:

dozens of classifications have been proposed, clinical forms have been described in detail, bacteriological and serological diagnostic methods have been improved, and new methods of etiological and Pathogenetic Therapy have been developed and implemented. This is primarily the merit of B.I. Badanov (1928), E.M. Vizen (1938), Z.L. Lurie (1947), V.A. Vlasov (1950), I.G. Vainshtein, N.I. Grashchenko (1962), D.S. Futer (1965), M.I. Levy (1964), V.I. Pokrovsky (1967), S.L. Kipnis (1968), Yu.A. Yakunin (1968), A.N. Shapoval (1971), Yu.I. Barashev (1971), B.Ya. Reznik, S.F. Spalek (1971), M.A. Dadiomova, Patusevych (1974), V.I. Pokrovsky et al. (1976), M.B. Tsuker (1978), V.S. Lobzin (1983), Yu.Ya. Vengerov, Yu.A. Skripnik (1985), R.D. Collins (1986), R.E. Berman, V.K. Vaughan (1987), M.B. Bitov, B.D. Lutsik (1990), V.V. Fomin et al. (1991), M.F. Kornev (1991), and Zh.I. Vozianova (2000), whose scientific developments and clinical observations were utilized in writing this monograph.

In publishing this book, our goal was to provide material based on the latest scientific achievements, reflecting the modern course and Clinical Features of meningitis in children, as well as the principles of diagnosis, Differential diagnosis, and treatment. The book is primarily intended for pediatricians across all levels of the pediatric healthcare system, as well as physicians of any specialty who encounter acute infectious pathology in children in their clinical practice.

Unlike eternal truths and life wisdom, the data on childhood meningitis presented in this monograph are constantly evolving. By the time this book reaches the reader, some time will have passed, which automatically makes it somewhat outdated. Therefore, all critical feedback and suggestions will be gratefully accepted by the authors.

HEAD of the Department of Pediatric Infectious Diseases at the Crimean State Medical University named after S.I. Georgievsky, Honored Worker of Science and Technology of Ukraine, Professor, Doctor of Medical Sciences I.V. Bogadelnikov; Head of the Department of Pediatric Infectious Diseases at the National Medical University named after O.O. Bogomolets, Honored Doctor of Ukraine, Professor, Doctor of Medical Sciences S.O. Kramaryov.