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668 Chapter 26 Nervous System Infections the glucose concentration normally present in the cerebrospinal fluid. The inflammatory response, with its formation of pus and clots, may cause brain swelling and infarcts, meaning death of tissue resulting from loss of blood supply. It can also lead to obstruction of the normal outflow of cerebrospinal fluid, causing the brain to be squeezed against the skull by the buildup of internal pressure. The infection may damage the nerves of hearing or vision or the motor nerves, producing paralysis. Moreover, N. meningitidis circulating in the bloodstream releases endotoxin, thereby causing a drop in blood pressure that can lead to shock. Shock is a state in which there is not enough blood pressure to circulate the blood adequately to meet the oxygen requirements of vital body tissues such as the kidneys and central nervous system. The smaller blood vessels of the skin are also damaged by the circulating meningococci, causing the petechiae. ■ pili, p. 65 ■ endotoxin, p. 475

The organism's endotoxin also increases the body's sensitivity to repeated endotoxin exposure. This strikingly increased sensitivity, called the Shwartzman phenomenon, can be demonstrated in experimental animals following repeated injections of meningococci. Intermittent "showers" of meningococci entering the blood from infected meninges are probably responsible for the rapidly fatal outcome in some human cases of meningitis. The tendency of meningococci to autolyse, meaning to rupture spontaneously, may enhance their release of endotoxin.

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