• CEREBRO-SPINAL FEVER

    Definition:

    Cerebro-spinal fever is an acute infections disease characterized by an inflammation of the meninges of the brain and spinal cord caused by the diplococcus intracellularis. It is accompanied by irregular systemic disturbances. Many cases have a petechial eruption, hence the names “spotted fever” and “petechial fever”.

    Historical Note: Cerebro-spinal fever was first described in 1805. Since then it has appeared in appeared in epidemic from in various parts of Europe and of the United States. In 1887 Weichselbaum discovered the diplococcus intracellularis, the specific germ of cerebro-spinal fever. In 1903-5 the disease prevailed quite generally in this country. In New York City in 1904 there were 3,029 deaths from cerebro-spinal fever; in 1905 there were 1,404 deaths. In 1909 there were 485 deaths from it in the entire state of New York.

    In 1907-1908 Simon Flexner published the results of the treatment of case of cerebro-spinal fever by the serum prepared by him.

    ETIOLOGY (Cause of Cerebro-spinal fever) :

    Cerebro-spinal fever is due to the bacillus intracellularis frist described by Weichselbaum in 1887. It’s mode of entrance into the body is probably by way of the nasal mucous membrane.

    Unfavorable hygiene and cdld weathefr seem to be predisposing causes. It is found most often in the poor quarters of large communities.

    The disease occurs 24 hr pharmacy. http://cialisgeneric20mgbest.com/. viagra dosage mostly in children and young adults. It frequently affects recruits in an army.

    Nurses and medical attendants on meningitis cases are some times attacked.

    Bacteriology: The meningococcus, or the diplococcus intracellularis, was discovered by Weichselbaum in 1887. It is a diplococcus consisting of paired hemispheres. It is found in the cerebro-spinal fluid in cases of epidemic cerebro-spinal meningitis. It is found frequently in the leucocytes, sometimes in the nucleus as well. It is sometimes found in the exudate in complicating arthritis and pneumonia.

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    The meningococcus will grow best in blood serum or agaragar. It will not survive long under cultivation.

    Morbid Anatomy and Pathology: In cerebro-spinal fever there is an excess of cerebro-spinal fluid. Instead of the fluid being clear, as is normal, it is at first cloudy or turbid, and later becomes fibro-purulent.

    On examination by the microscope the meningococcus will be found in the fluid.

    The meninges show thickening and changes due to inflammation.

    A leucocytosis is the rule.

    On examination by the microscope the meningococcus will be found in the fluid.

    The meninges show thickening and changes due to inflammation.

    A leucocytosis is the rule.

    Symptoms:

    The onset of cerebro-spinal fever is usually abrupt. There is headache, retraction of the head and back, vomiting. chilliness, sometimes chills, frequently delirium and convulsions, and sometimes coma. All of these symptoms may be so sudden and so severe that the patient, overwhelmed by the toxemia, succumbs in a very few hours.

    Other cases are ushered in abruptly with a chill or chilliness. There are headache and pain in the neck, back and legs. The head is drawn back and there may be even opisthotonos. Sometimes the bending of the body is sideways, pleuro-thotonos, in stead of backwards.

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    Convulsions are frequent, coma less so. Delirium may be an early symptom, especially in children. Projectile vomiting takes place.

    The temperature rises to 102°, sometimes tQ 1060 F. or higher. Chapin reports a case where the temperature was io8.6° F. The pulse and respiration are increased but the increase is variable and irregular.

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    Herpes appears about the face, and a petechial eruption often appears on the body. This last may be slight, or it may be profuse. In malignant cases the eruption may be purpuric. Chapin reports that the skin eruption was rare in the epidemic of 1904.

    The various reflexes—the patellar, plantar, epigastric, either become exaggerated or are lost. Kernig’s sign is present. This is an inability to straighten the leg when the thigh is at right angles to the body.

    Eye symptoms are marked. There may be photophobia, often strabismus. Frequently the sight is lost. The eyes may be open but the patient apparentl\sees nothing. There is anesthesia of the eyeballs. On account of this lack of sensibility conjunctivitis is liable to develop.

    Deafness is also a common symptom.

    The excess of fluid in the veitricles permits the eliciting of Macewan’s sign. This is done b3\having the patient sit upright with the head to one side. Percussion over the parietal or lower part of the frontal region gives a tympanitic note.

    Hyperesthesias and anesthesias may be found in various parts of the body. Maier found a true muscle soreness rather than a hyperesthesia.

    Twitchings of muscles or groups of muscles occur during the disease. Later the body may be in a state of tonic spasm.

    Paralysis of different nerves occurs.

    Leucocytosis is the rule.

    Complications and Sequelæ: A more or less frequent complication of cerebro-spinal fever is pneumonia.

     

    Hydrocephalus sometimes is a complication.

    Sequelæ are usual and very distressing. One or more of the special senses may be permanently destroyed, particularly sight and hearing.

    The brain may be permanently injured and the patient become idiotic.

    Joint contractures may result. Emaciation is common.

    Diagnosis: Clinically, epidemic cerebro-spinal meningitis may resemble typhus fever, a comparatively rare disease in the United States. The retraction of the head is not present in typhus, it is in cerebro-spinal fever.

    Tubercular meningitis and cerebro-spinal fever may resemble each other closely. ‘The first is of slower onset; moreover, it is apt to be part of a general tubercular infection, or to occur where: there is a family history of tuberculosis.

     

    Typhoid fever has a very different history from cerebro-spinal fever.

    In all cases of suspected cerebro-spinal fever lumbar puncture should l made and sorne of the fluid drawn off. rn this disease the fluid is turbid, not clear, and-the microscope will show the meningococcus.

    Lumbar puncture is made primarily for diagnosis. It has also been found that lumbar puncture, by relieving intra-dural pressure, is beneficial as a method of treatment.

    Technique: The skin where the punctureis to be made should be sterilized. This point of election may be between the third and fourth, or the fourth and fifth lumbar vertebræ, or between the fifth lumbar and the first sacral. An aspirating needle, or a small trocar and canula, may be used. It should be 9 to ro cm. long with a lumen of 1mm. The needle should be inserted one half cm. below the spinous process of the vertebra it is decided to puncture under, and one cm. to the right or left. The needle is then pushed upward, inward and forward. The canal is reached at a distance of 2 to 7 cm., according to the size and age of the patient, whether child or adult. If the canal is reached the cerebro-spinal fluid will run out dròp by drop, if not there will be nothing.

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    Sometimes when the fluid is gotten a little blood is mixed with it. The microscope will differentiate the bibod elements from other substances. The normal fluid is clear; in cerebro-spinal fever it is turbid.

    Prognosis: The prognosis of cerebro-spinal fevër is bad. The mortality is high. Patients who do not die are nearly always left in such a pitiable condition, with loss of mind, or loss of sight or hearing, or with sorne deformity, that it would seem as though death were preferable.

    Treatment: During the New York epidemic of cerebro-spinal meningitis of I9o4-Iço5 a special commission was appointed by the city board of health to investigate the entire subject. They concluded that the disease was undoubtedly mildly infectious: They also found that the contagion was probably transmitted by the nasal discharges.

    In the light of these findings the patient suffering from epidemic cerebro-spinal meningitis should be isolated. He should be placed under the most advantageous hygienic surroundings. All discharges—particularly from the nose and throat—should be immediately destroyed.

    The diet must be liquid at first. It should be full and nourishing during convalescence. It may be necessary to feed with a stomach tube.

    Morphine may be used to quiet the patient. Ice bags applied to the head and spine are valuable adjuncts.

    In 1907 Simon Flexner made known his antirneningitic serum prepared from the horse. Since then it has been largely used and has apparently reduced the mortality from 75 to 8o per cent. to

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    less than thirty.

    In 1908 Flexner and Jobling presented a paper to the American Pediatric Society reporting on 393 cases treated with the serum.The mortality was 25 per cent.

     

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