meningitis
Introduction
Introduction to meningitis Meningitis is a disease in which a delicate meninges or meninges (a membrane between the skull and the brain) is infected. This disease is usually accompanied by complications of bacteria or viruses that infect any part of the body, such as the ear, sinus or Upper respiratory tract infection. Meningitis is a particularly serious condition that requires timely treatment. If the treatment is not timely, it may die within a few hours or cause permanent brain damage. Viral meningitis is more serious but most people can recover completely, with a few legacy sequelae. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: coma brain abscess shock
Cause
Cause of meningitis
Bacterial meningitis (25%):
Bacterial meningitis is caused by certain bacterial infections, which are divided into three types, namely Haemophilus influenzae type B, Neisseria meningitidis (diseococcus) and Streptococcus pneumoniae (pneumococcus), and about 80% of bacteria in the United States are bacteria. Meningitis, usually a small group of healthy people carrying these bacteria in the nose or on the surface does not invade the human body, he spreads through coughing or sneezing, some studies indicate that people are most susceptible to infection by the bacteria in the case of a cold, because the nose is inflamed and bacteria Getting into the skull becomes extremely easy.
Tuberculous meningitis (25%):
Tuberculous meningitis is a non-suppurative inflammation of the meninges caused by Mycobacterium tuberculosis, which accounts for about 6% of systemic tuberculosis. Mycobacterium tuberculosis infection is spread under the soft meninges to form tuberculous nodules after disseminated by blood, and a large number of nodules Tuberculosis enters the subarachnoid space. In recent years, the incidence and mortality of tuberculous meningitis have increased. Early diagnosis and treatment can improve the efficacy and reduce mortality.
Viral meningitis (35%):
Viral meningitis can be caused by several viruses, including several diarrhea-related viruses, one of which may be infected by bites such as voles.
Cryptococcal meningitis (15%):
Cryptococcal meningitis can also be caused by fungi. The most common one is cryptococcus, which can be found in pigeons. Healthy people are less susceptible to fungal meningitis, but different for those infected with HIV. It is a human immunodeficiency virus that can cause AIDS.
Prevention
Meningitis prevention
(1) Early detection of patients, isolation treatment on the spot.
(2) Do a good job in publicity during the popular period. Avoid large-scale gatherings and group activities. Do not bring children to public places. Wear masks when going out.
(3) Drug prevention: Sulfamide drugs are still used in China, and those with close contact can use iodamine (SD), adults 2g/day, 2 times with the same amount of sodium bicarbonate, even for 3 days; children daily for 100mg /kg, in the epidemic of meningitis, who have: 1 fever with headache, 2 wilting, 3 acute pharyngitis, 4 skin, oral mucosal hemorrhage, etc., can give a full range of sulfa drug treatment, can Effectively reduce the incidence and prevent epidemics, foreign use of rifampicin or minocycline for prevention, rifampicin 600 mg daily, even for 5 days, 1 to 12 years old children daily dose of 10 mg / kg.
(4) Vaccine prevention: At present, the two groups of capsular polysaccharide vaccines of A and C are widely used at home and abroad. The protection rate of group A polysaccharide vaccine purified by ultracentrifugation is 94.9%, and the average antibody titer after immunization is increased by 14.1 times. In China, polysaccharide vaccines are also used as emergency preventers. If the incidence of meningitis in January-February is greater than 10/10 million, or the incidence rate is higher than the same period of the previous year, vaccination can be carried out in the population.
Complication
Meningitis complications Complications, coma, brain abscess, shock
1. When meningitis occurs, purulent exudate is easy to block narrow channels or adhesions, causing cerebrospinal circulatory disorders, resulting in hydrocephalus, which is common in patients who are treated improperly or treated too late, especially in newborns and small babies. Adhesive arachnoiditis occurs in the occipital foramen, which can block the circulation of cerebrospinal fluid; or the formation of adhesions in ventriculitis, which is the common cause of obstructive hydrocephalus.
2, in addition to vomiting, from time to time and other reasons can cause water, electrolyte disorders, but also see cerebral hyponatremia, paralysis, convulsions, coma, edema, weak body weakness, low limb muscle tone, oliguria and other symptoms The occurrence principle and infection affect the posterior lobe of the pituitary gland, so that excessive secretion of antidiuretic hormone leads to water retention.
3, due to brain parenchymal damage and adhesions can cause cranial nerve involvement or limb paralysis, brain abscess, intracranial arteritis and secondary epilepsy can be done, violent hair flow can be associated with DIC, shock, in addition, otitis media Pneumonia, arthritis can also occur.
Symptom
Symptoms of meningitis Common symptoms Cerebrospinal fluid protein increased water, sodium retention obesity convulsions appetite loss high fever newborn pus
According to the history of otitis media and signs of meningitis, lumbar puncture cerebrospinal fluid test, general diagnosis is not difficult. In recent years, due to the wide application of broad-spectrum antibiotics, acute conditions are mostly inhibited, cerebrospinal fluid chemical changes are small, protein may increase slightly, sugar and oxide In the normal range, there is a slight increase in white blood cells, especially improper treatment, which can become a focal or protracted meningitis, which is easily confused with light tuberculous meningitis or epidemic cerebrospinal meningitis.
Examine
Examination of meningitis
1, high fever (> 40 ° C), neck stiffness, severe headache, loss of appetite, unconsciousness, vomiting, convulsions, burnout, sleep, sensitive to light, small blood spots on the skin, skin rash {by its underarms The symptoms of meningitis and the symptoms of colds are often the cause of misdiagnosis. Symptom changes may occur in one to two days, and some may be life-threatening in a few hours.
2, in infants and newborns, high fever, headache, neck stiffness is not a typical symptom, and sometimes there is a low temperature situation, the symptoms of this group of patients are: sharp and continuous crying, unusual sleep, appetite Very poor, very sensitive, and some cases where the door is inflated.
3, in the elderly, the above symptoms may or may not appear, but will show hidden symptoms, such as unconsciousness, dullness.
4, severe bacterial meningitis can also have shock, coma or convulsions [like epilepsy] symptoms.
Diagnosis
Diagnosis and differentiation of meningitis
Differential diagnosis
1, purulent meningitis
The most confusing one is Haemophilus influenzae meningitis, because it is more common in children under 2 years old, the number of cerebrospinal fluid cells is sometimes not very high, followed by meningococcal meningitis and pneumococcal meningitis, identification of tuberculosis exposure History, lignin reaction and X-ray examination of the lung can help diagnose, the important thing is the cerebrospinal examination, in the case of higher than the number of cells, the important thing is cerebrospinal fluid examination, the number of cells is higher than 1000×106/L (1000/ Mm2), and when the majority of neutral polymorphonuclear granulocytes are classified, suppurative meningitis should be considered; but more important is cytology.
2. Viral central nervous system infection
Mainly viral encephalitis, viral meningoencephalitis and viral myelitis can be confused with the brain, in which viral encephalitis is more need to be identified than the epidemic, the diagnosis of various viral meningitis is:
1 often has a specific season,
2 each has its own special systemic manifestations, such as enteroviruses with diarrhea, rash or myocarditis
3 cerebrospinal fluid changes in addition to cell number and classification and brain is not easy to identify, biochemical changes are not the same, viral meningoencephalitis cerebrospinal fluid sugar and chloride normal or slightly higher, protein is not obvious, more than 1g / L (100mg / Dl),
4 various viral encephalitis or meningitis have their own specific laboratory diagnostic methods, such as serological examination and virus isolation (see the relevant sections), light viral encephalitis and early brain identification is more difficult.
The principle of treatment is: 1 first treatment with anti-tuberculosis drugs, at the same time carry out various tests, such as lignin test, lung X-ray film to assist diagnosis, 2 no hormone treatment, such as short-term cerebrospinal fluid return to normal, mostly viral encephalitis Non-conjunctiva, 3 no injection of any drug in the sheath, so as not to cause changes in the composition of the cerebrospinal fluid to increase the difficulty of differential diagnosis.
3. New cryptococcal meningoencephalitis
Its clinical manifestations, chronic course of disease and cerebrospinal fluid changes can be similar to the brain, but the course of disease is longer, can be accompanied by spontaneous relief, chronic progressive high intracranial pressure symptoms are more prominent, and other manifestations of meningitis are not equal, the disease is rare in Xiaoyan Therefore, it is easy to be misdiagnosed as the brain, and the diagnosis is based on the smear of the cerebrospinal fluid. The ink is stained with black ink to reflect the round shape. The cryptococcal spores with thick capsule refraction have the growth of Cryptococcus neoformans on the sand-protecting medium.
4, brain abscess
Children with brain abscess have a history of otitis media or head trauma, sometimes secondary to sepsis, often accompanied by congenital heart disease. Children with brain abscess often have focal brain signs in addition to meningitis and high intracranial pressure. Cerebrospinal fluid changes in the absence of secondary purulent meningitis, the number of cells can range from normal to hundreds, most of them are lymphocytes, sugar and chloride are normal, protein is normal or increased, differential diagnosis by means of ultrasound, EEG, brain CT And cerebral angiography and other tests.
5. But the difference between brain tumor and brain is:
1 less fever.
2 convulsions are less common, even if there is convulsions, most of them are conscious after pumping, and children with advanced cerebral palsy are in a coma after convulsions.
3 coma is less common.
4 high intracranial pressure symptoms and brain signs are not parallel.
5 Cerebrospinal fluid changes are little or slight.
6 The nodules test is negative and the lungs are normal. For the diagnosis of brain tumors, brain CT scans should be performed in time to assist in diagnosis.
6, the typical diagnosis of the brain is easier, but some are not typical, the diagnosis is more difficult, the typical brain is about the following situations:
1 Infants and young children have an acute onset, and they are progressing rapidly. Sometimes they can be convulsed as the first symptom.
2 early symptoms of brain parenchymal damage, manifested as chorea or mental disorders.
3 early cerebrovascular damage, manifested as limb paralysis.
4 When combined with brain tuberculoma, it can be like intracranial tumor manifestations.
5 other parts of the tuberculosis lesions are extremely serious, can mask the symptoms and signs of meningitis and are not easy to identify.
6 When meningitis occurs during anti-tuberculosis treatment, it often appears to be frustrated. For the above various atypical scales, the diagnosis needs to be particularly careful to prevent misdiagnosis.
