UA140008U - METHOD OF ASSESSING THE DEGREE OF ACUTE BACTERIAL MENINGITIS OF MENINGOCOCCAL ETIOLOGY - Google Patents

Abstract

A method of assessing the severity of acute bacterial meningitis of meningococcal etiology includes biochemical examination of cerebrospinal fluid. Determine the content of thyroid-stimulating hormone and if its value is less than or equal to 4.18 mIU / l diagnose the average severity of acute bacterial meningitis of meningococcal etiology, if the value is more than 4.18 mIU / l - severe.

Description

A useful model belongs to medicine, namely infectious diseases and neurology, and can be used to assess the severity of acute bacterial meningitis of meningococcal etiology.

Acute bacterial meningitis of meningococcal etiology at the present stage occupies an important place in the general structure of infections of the nervous system. They are characterized mainly by a severe course and, accordingly, a high frequency of fatal consequences, which currently vary from 10 to 20 95. Adequate assessment of the severity of the disease makes it possible to carry out clinical monitoring, early correction of therapy, which will contribute to improving the results of treatment, increasing its effectiveness, shortening the patient's stay in the hospital, reducing the risk of disability and mortality. Therefore, establishing the degree of severity of acute bacterial meningitis of meningococcal etiology is necessary, and the search for accessible and accurate methods of its assessment is an important task.

There is a known method of assessing the degree of severity of bacterial meningitis based on determining the content of interleukin-10 in the patient's blood serum on the 1st-6th day after the onset of the disease. In the case of a severe course of meningococcal meningitis, this indicator is 4.24-4.58 pkg/ml, in the case of a mild or medium-severe course, 7.21-7.75 pkg/ml (Pat. Mo 2309489 SI. KO, MPK 01 33/68. / Nazarochkina O .V., Kharchenko O.A., Ivanov P.L. - 3. Mo. 2005139465/15; Application: 16.12.2005.

Publ. 27.10.2007. A method of assessing the severity of meningococcal and viral meningitis in children.

Despite the ease of interpretation of the obtained results and the simplicity of the method, it involves measuring the universal anti-inflammatory cytokine only in the blood without taking into account its content in the cerebrospinal fluid and therefore has low specificity. In addition, the determination of interleukin-10 requires the presence of special expensive equipment and reagents, that is, it is not economically feasible. As a result, this method is difficult to reproduce and cannot be used in everyday clinical practice.

There is a known method in which the content of alpha 2-macroglobulin in the cerebrospinal fluid, which is determined by the method of immunoturbidimetry, is used as an indicator of the severity of the inflammatory process in bacterial purulent meningitis. The value of this indicator in the range of 0.7-2.9 mg/dL corresponds to moderately severe inflammation, 3.0-8.0 mg/dL to severe, above 8.1 mg/dL to extremely severe inflammation (Pat. Mo 2340902 C1. KO. IPK S01M 33/68. / FSU Scientific Research Institute of Children's Infections. Alekseeva L.A., Skrypchenko N.V., Shanova M.V.

Shevchenko K.O., Bessonova T.V. 3. - Meo2007116089/15; Application 27.4.2007; Publ. 10.12.2008.

A method of diagnosing the severity of the inflammatory process in bacterial purulent meningitis in children). The level of the alpha-2-macroglobulin protein in the cerebrospinal fluid largely depends not only on the permeability of the blood-brain barrier, but also on its content in the blood serum, which is influenced by a number of factors, namely, the presence of pancreatitis, nephritis, gastroenteritis with protein loss, pulmonary emphysema, burns, mechanical injuries, malignant tumors, cryptogenic hepatitis, etc., which complicates the interpretation of the obtained results and limits its application.

There is also a way to assess the severity of acute bacterial meningitis, which includes the study of pools of high- and low-molecular components, which are determined by fractionation of the centrifuged cerebrospinal fluid by gel filtration on Sephadex.

If this indicator is in the range of 0.3-0.5 g/l, a medium-severe course of the disease is predicted, if it is in the range of 0.5-1.1 g/l - a severe course, if it exceeds 1.11 g/l - extremely severe the course of the disease (Pat. Mo. 2141668 SI, KO, MPK S01M 33/68. / Scientific Research Institute of Children's Infections, L.A. Alekseeva, M.N. Sorokina, V.V. Karasev - 3. Mo. 98109204/14;

Application 19.05.1998. Publ. 20.11.1999. A method of predicting the course and outcomes of bacterial purulent meningitis in children). The disadvantages of the method are the need for an additional multicomponent study and assessment of the content of a certain complex of cerebrospinal fluid proteins, which can be considered economically impractical, a certain dependence of these indicators not only on the damage to the central nervous system, but also on the severity of intoxication of the body. In addition, normal values of protein in the cerebrospinal fluid are formed due to the average molecular fraction entering from the blood plasma and varying in a wide range. Quantitative assessment of the pools of components of the cerebrospinal fluid, which have different origins, does not make it possible to accurately and quickly diagnose the degree of the inflammatory process in the brain. This helps to reduce the specificity of the indicators used in the method.

There is a way to assess the severity of acute bacterial meningitis, in particular of meningococcal etiology, based on determining the level of lactoferrin in the cerebrospinal fluid of patients with acute bacterial meningitis. The level of lactoferrin from 0.12 mg/l to 0.53 mg/l corresponds to the average severity of the disease, from 0.54 mg/l to 1.76 mg/l to the severe degree of severity

IZakharova EV...V. Acute meningitis in adults. Clinical-liquorological comparisons:

Autoref. thesis ... Doctor of Medicine - Novosibirsk, 2007. - September 22.

This method of assessing the severity of acute bacterial meningitis of meningococcal etiology is the closest to what is claimed, in terms of technical essence and the result that can be achieved, therefore it was chosen as the closest analogue.

The main disadvantage of the closest analogue is the fact that the indicator used in the method correlates not only with the severity of meningitis, but also with the etiology of the disease and the nature of the cerebrospinal fluid, which can in some way affect its sensitivity and specificity.

Lactoferrin is synthesized exclusively by the glandular cells of the epithelial tissues of the digestive, respiratory and reproductive systems and is a non-specific factor in the protection of the human body, the concentration of which in the blood is affected by various factors, in particular, the presence of a neoplastic process (a neoplasm of the digestive tract, leukemia, etc.). All this can significantly affect the evaluation of the research result. In addition, the determination of lactoferrin in cerebrospinal fluid does not belong to the generally accepted routine methods and therefore requires additional costs for test systems and equipment.

In connection with the above, the basis of a useful model is the task of increasing the accuracy of assessing the degree of severity of acute bacterial meningitis of meningococcal etiology.

The problem, which is the basis of a useful model, is solved by the fact that in the known method of assessing the severity of acute bacterial meningitis of meningococcal etiology, which includes a biochemical study of the cerebrospinal fluid, according to the useful model, the content of thyroid-stimulating hormone (TSH) is determined and when its value is less or equal to 4.18 mMoO/l diagnoses an average degree of severity of acute bacterial meningitis of meningococcal etiology, with a value greater than 4.18 mMoO/l - a severe degree.

The technical effect of the useful model, namely the increase in the accuracy of the assessment of the degree of severity of acute bacterial meningitis of meningococcal etiology, is due to the synergism of the declared measures.

The method is performed as follows: in a patient with suspicion of acute bacterial meningitis, cerebrospinal fluid is collected and routine general clinical and biochemical tests are performed. In the case of confirmation of the diagnosis, the DNA of M. tepipoiiaiv is determined by the method

From the polymerase chain reaction and in its presence, the content of the TSH hormone is additionally determined by enzyme immunoassay or another known method. If the value of this indicator is less than or equal to 4.18 mMOO/l, the average degree of severity of acute bacterial meningitis of meningococcal etiology is diagnosed, if the value is more than 4.18 mMOO/l - severe degree.

The effectiveness of the method has been proven by clinical studies. 33 patients with acute bacterial meningitis of meningococcal etiology were examined. According to the severity of the disease, the patients were divided into two groups. The first group consisted of 12 patients with acute meningococcal meningitis of a moderate-severe course, the second 21 patients with acute meningococcal meningitis of a severe course. As a control group, 30 people without signs of meningitis were examined. The results of the examination are shown in the table, which indicates a reliable difference of the investigated indicator in groups of patients with different severity of the disease. The critical value of the indicator was determined as (M-t) in the second group of patients (4.56-0.38-4.18). Conducting the Piersop analysis made it possible to establish that the content of the TSH hormone in the cerebrospinal fluid in patients with acute bacterial meningitis of meningococcal etiology, which exceeds 4.18 mMoO/l, occurred more often in the second group of patients with a probability of 95% than in the first group (x7- 3.96; p«e0.05).

Table

The content of TSH in the cerebrospinal fluid of patients with acute meningococcal meningitis, (Mat)

Indicator | prose kvorikh t VOVNA vo ri»0.05

TSH, mMoO/l 3.16.0.37 4.5610.38 2.8570.18 rg-0.001 rz«0.02

Note: p: - difference between group I patients and control; rg2 - difference between patients of II group and control; rz - the difference between groups of patients.

The method is illustrated by the following examples of its clinical application:

Example Mo 1

Patient B., 53 years old. Diagnosis: acute meningococcal meningitis. The content of TSH in the cerebrospinal fluid when the patient was hospitalized was 2.32 mIU/l, which indicates the average severity of the disease. Based on the set of clinical and laboratory signs, the final diagnosis was established: acute meningococcal meningitis of meningococcal etiology, of moderate severity.

Example Mo 2

Patient A., 45 years old. Diagnosis: acute meningococcal meningitis. The content of TSH in the cerebrospinal fluid when the patient was hospitalized was 2.61 mMoO/l, which indicates an average degree of severity of bacterial meningitis. Based on the set of clinical and laboratory signs, the final diagnosis was established: acute meningococcal meningitis of meningococcal etiology, of moderate severity.

An example of Mo Z

Patient N., 48 years old. Diagnosis: acute meningococcal meningitis. The content of TSH in the cerebrospinal fluid when the patient was hospitalized was 5.1 mIU/l, which indicates a severe course of the disease. Based on the set of clinical and laboratory signs, the final diagnosis was established: acute meningococcal meningitis of meningococcal etiology, severe, complicated by cerebral edema.

Example Mo 4

Patient R., 68 years old. Diagnosis: acute meningococcal meningitis. The content of TSH in the cerebrospinal fluid when the patient was hospitalized was 7.88 mIU/l, which indicates a severe course of the disease. On the basis of a complex of clinical and laboratory signs, the final diagnosis was established: acute meningococcal meningitis of meningococcal etiology, of severe severity, complicated by cerebral edema.

Adequate assessment of the severity of acute bacterial meningitis of meningococcal etiology is of great importance, as it allows for timely correction of therapy, in particular the volume of emergency care, to improve the prognosis of the disease, to reduce mortality rates from bacterial meningitis, and to shorten the patient's stay in the hospital.

Coo)

Claims (1)

USEFUL MODEL FORMULA A method of assessing the severity of acute bacterial meningitis of meningococcal etiology, which includes a biochemical study of cerebrospinal fluid, which is distinguished by the fact that the content of thyroid-stimulating hormone is determined and if its value is less than or equal to 4.18 mIU/l, the average degree of severity of acute bacterial meningococcal meningitis is diagnosed etiology, with a value of more than 4.18 mMoO/l - a severe degree.