Enteric gram-negative bacilli meningitis
Introduction
Brief introduction of intestinal Gram-negative bacilli meningitis Intestinal Gram-negative bacilli Meningitis is a bacterium belonging to the family Enterobacteriaceae, including Escherichia coli, Salmonella, Citrobacter, gas-producing or Enterobacter cloacae, Klebsiella, Proteus, Edwards, etc. Gram-negative bacilli. Such bacteria generally do not cause diseases in the intestines, and only under certain conditions, when they enter other organs, they are pathogenic, so they are called conditional pathogens. basic knowledge Sickness ratio: 0.5% Susceptible people: good for newborns Mode of infection: non-infectious Complications: meningitis
Cause
Intestinal Gram-negative bacilli meningitis etiology
Mother-to-child transmission (30%):
The pathogenic bacteria of meningitis are mainly Gram-negative bacilli, accounting for 60%-80%, especially Escherichia coli. The pathogens are from the mother's birth canal or rectum. The sick children have premature rupture of membranes and the labor process is too long. Dystocia, premature birth, underweight, etc.
Postpartum infection (35%):
The pathogens of postpartum infection are mostly invaded by the respiratory tract, oral mucosa, umbilicus, skin, middle ear, etc., and then reach the meninges. Infants with congenital anatomical defects such as skull fracture, spina bifida, meningocene or skin traffic In infants with sexual sinus, pathogens invade the meninges directly through defects.
Neonatal infection factors (5%):
Newborns are often caused by premature birth, damaging delivery and maternal infection. In the neonatal period, due to the lack of bactericidal IgM antibodies, there is a high susceptibility to E. coli infection, and infants and the elderly have low defense function. It is also easy to develop.
Low immunity (30%):
Middle-aged people often occur in the late stage of patients with underlying diseases, using immunosuppressive therapy, indwelling intravenous catheters, catheters, etc., so that bacteria have the opportunity to enter the bloodstream, causing sepsis, and then develop into meningitis, craniocerebral trauma Or craniocerebral surgery and sinus, mastoid and other focal infections or surgery, bacteria can directly enter the meninges and cause meningitis, neonatal meningitis and otitis meningitis are often caused by Gram-negative bacilli, otitis meningitis On the basis of epidermoid tumor (also known as cholesteatoma) otitis media and mastoiditis, bacteria enter the pia mater and arachnoid and cause diffuse suppurative inflammation. The pathogen is often caused by Proteus, Escherichia coli, and influenza bacillus. Caused by Pseudomonas aeruginosa and other intestinal Gram-negative bacilli, the disease can occur in various age groups, children and young people can be caused by acute suppurative otitis media, acute mastoiditis, while the elderly often occur in chronic suppuration Acute episodes of otitis media, especially epidermoid tumors (also known as cholesteatoma) otitis media, pathogenic bacteria mainly enter the skull through the erosion of bone, can also be infected by blood or by The rock tip inflammation enters the skull along the inner auditory canal.
Prevention
Intestinal Gram-negative bacilli meningitis prevention
The prevention of this disease is mainly to timely and rationally treat inflammation and sepsis in the peri-cerebral organs. Neurosurgery and lumbar puncture should pay attention to aseptic and anti-virus, prevent infection, and prevent obstructive delivery in obstetrics.
Complication
Complications of intestinal Gram-negative bacilli meningitis Complications meningitis
Concurrent ventriculitis.
Symptom
Intestinal Gram-negative bacilli meningitis symptoms Common symptoms Shock high fever bloating convulsions Dyspnea hepatosplenomegaly septicemia
Similar to other bacterial meningitis, but neonates, especially premature infants, often lack typical clinical manifestations and are easily misdiagnosed because of neonatal anterior hernia, posterior hernia, patent suture, cervical muscle underdevelopment, central nervous system. The phylogeny is imperfect, so the performance of intracranial hypertension and the signs of neck stiffness are often not obvious. The main manifestations are weakness of sputum, reduced or even refusal of sputum, wilting, vomiting, irritability, screaming, lethargy, difficulty breathing, cyanosis, etc. The body temperature is unstable, the body temperature of premature infants often does not rise, the full-term children may have fever, the onset of childhood is more urgent, there are high fever, headache, lack of appetite, vomiting, listlessness and other symptoms, the mind is generally awake, the condition Progress can occur convulsions, convulsions, coma and even shock. When the intracranial pressure is significantly increased, it can cause cerebral palsy, pupils, respiratory and heart rate changes, and even respiratory and circulatory failure. This disease is easily complicated by ventriculitis, which is a poor prognosis. And one of the causes of severe sequelae, diffuse meningitis, high fever, persistent headache and neck stiffness, early headache is confined to the affected side, after the headache is aggravated And spread the entire head, severe convulsions, coma, etc., otitis meningitis often have thrombotic sinusitis or brain abscess, should be noted, there may be sputum in patients with sepsis, sputum, abdominal distension, hepatosplenomegaly Big, shock, etc.
Examine
Examination of intestinal Gram-negative bacilli meningitis
Lumbar puncture for cerebrospinal fluid routine, smear and culture examination, when the smear is negative, can be used as sputum lysate test and lactate dehydrogenase test, latex agglutination test, convective immunoelectrophoresis, direct immunofluorescence antibody test, detection of bacterial antigen in cerebrospinal fluid It is sensitive and specific, and is not affected by antibiotic treatment. It has clinical significance for the diagnosis of this disease.
X-ray examination often has mastoid bone destruction.
Diagnosis
Diagnosis and differential diagnosis of intestinal Gram-negative bacilli meningitis
Patients with clinical diagnosis and suspected meningitis should be treated with lumbar puncture for cerebrospinal fluid routine, smear and culture examination. When smear is negative, it can be used as sputum lysate test and lactate dehydrogenase test, latex agglutination test, convection Immunoelectrophoresis, direct immunofluorescence antibody test, detection of bacterial antigen in cerebrospinal fluid is rapid, sensitive, specific, and is not affected by antibiotic treatment. For the diagnosis of this disease, the clinical significance of suspected brain abscess should be timely CT scan to clear diagnosis.
The disease should be differentiated from other purulent meningitis, viral meningitis, tuberculous meningitis.
