Bacterial meningitis in the elderly
Introduction
Introduction to bacterial meningitis in the elderly Microorganisms spread into the subarachnoid space through distant infection sources or asymptomatic occult lesions or directly invade from adjacent infections, resulting in meningitis. Because the immune defense system of the subarachnoid space is limited, the infection spreads rapidly. If it is acute, Severe infection and treatment is not timely, can quickly endanger the patient's life, especially in elderly patients, common sputum is the most common pathogen of the elderly central nervous system infection. Viruses, tuberculosis, fungi, and spirochetes are rare. It is currently believed that older people are more likely to suffer from certain central nervous system infections (infectionsofthecentralnervoussystem) than younger people, and the prognosis is poor. This is likely to be caused by poor physical condition, malnutrition and long-term hospitalization due to some chronic diseases. Not due to age-related immune deficiencies. basic knowledge The proportion of sickness: 0.63% Susceptible people: the elderly Mode of infection: non-infectious Complications: pericarditis, arrhythmia
Cause
The cause of bacterial meningitis in the elderly
Pathogen infection (35%):
The most common cause of bacterial meningitis is Streptococcus pneumoniae, which accounts for about 50%. Neisseria and monocytogenes are 10% each. The other 25% of pathogens include leather. Blue-negative bacilli, Staphylococcus aureus, anaerobic bacteria, etc.
Blood-borne (20%):
Bacteria may first enter the ventricles through the choroid plexus, cause the cerebrospinal fluid to be infected, and then circulate through the cerebrospinal fluid into the subarachnoid space to form meningitis, a meningitis that occurs on the basis of sepsis.
Other (15%):
Invasion of cerebrospinal fluid from traumatic sites, sinusitis, otitis media, and mastoiditis can increase the likelihood of infection and invasion of the central nervous system. Non-traumatic, post-operative Golden Staphylococcus purulent meningitis, often caused by bacterial dissemination of bacterial endocarditis sepsis, pneumonia streptococcal meningitis often accompanied by pneumonia, sinusitis, otitis media, and Most Gram-negative bacilli and anaerobic meningitis are often secondary to surgery, intestinal obstruction, urinary tract infections, and after cellulitis, typical monocytogenes of Listeria infections are common in meningitis. Patients with low immune function and steroid use can't find a source of infection.
Prevention
Bacterial meningitis prevention in the elderly
Physical exercise should be increased to improve the body's immunity.
Complication
Bacterial meningitis complications in the elderly Complications pericarditis arrhythmia
Concurrent pericarditis, arrhythmia.
Symptom
Bacterial meningitis symptoms in the elderly Common symptoms Bacterial infections Joint swelling, pain, rash, rash, sleepiness, confusion, skin, ecchymosis, coma, coma
Symptoms, signs: acute phase often manifested as: fever, headache, vomiting, neck stiffness and consciousness changes, confusion, drowsiness to coma, convulsions and nervous system focal signs are rare, because the elderly because of varying degrees of Brain atrophy, cerebral arteriosclerosis, physiological dysfunction, decreased immune function, so its clinical symptoms are often atypical, often only mild headache, low fever without vomiting and confusion, memory loss and disorientation, may be the only early meningitis Symptoms, although these symptoms are non-specific, meningitis should be considered in elderly patients with these symptoms. Systemic symptoms of sepsis after meningococcal infection include pericarditis, arrhythmia, ST segment depression and joint pain, easily misdiagnosed as ischemic heart Disease or joint disease, the elderly are prone to rash, especially after the application of antibiotics, there may be purpura after infection with Streptococcus pneumoniae, and diffuse pink mucosal erythema can be seen after infection with Listeria, which should be associated with meningococcal infection. After the skin ecchymosis and ecchymosis erythema identification.
Examine
Examination of bacterial meningitis in the elderly
1. Peripheral blood test
The number of white blood cells in the elderly may not be high due to decreased immune function, but the neutral classification is often increased.
2. Cerebrospinal fluid examination
Typical bacterial meningitis Cerebrospinal fluid: appearance turbid or pus-like, increased pressure, significantly increased protein quantitation, up to 1000 ~ 5000mg / L or more, reduced sugar content, generally 0.055 ~ 0.1mmol / L, or even lower, determination of cerebrospinal fluid The blood glucose level should be measured at the same time. Because meningitis aggravates diabetes, the sugar content in the cerebrospinal fluid can be increased or normal, the chloride is reduced, and the total number of white blood cells is (500-1000)×106/L. Neutral-based, Gram-coated Corresponding pathogens can be found in tablets and bacterial cultures.
Imaging examination: Generally, after the treatment is started, the condition is stable and the sinus and chest film can have inflammatory changes. Generally, there is no obvious abnormality in the CT scan of bacterial meningitis. In some patients, the enhancement of the cerebellum is obvious. Patchy enhancement.
Diagnosis
Diagnosis and differential diagnosis of bacterial meningitis in the elderly
Diagnostic criteria
The diagnosis of bacterial meningitis depends on medical history, clinical manifestations and changes in cerebrospinal fluid.
1. History must be detailed in the following cases before and after the disease:
(1) Skin purulent infection and presence or absence of other infections.
(2) With or without otitis media, sinusitis, and history of pulmonary infection.
(3) History of head trauma.
(4) Whether there is diabetes, malignant tumor, or history of steroid treatment.
2. Clinical manifestations of the clinical features of the elderly, mild headache, no vomiting, fever is not obvious, but with a change in consciousness and mentality, meningitis stimulates less sign.
3. Cerebrospinal fluid changes were positive for bacterial infection and bacteriological examination.
Differential diagnosis
1. First of all, to distinguish from other central nervous system infections, tuberculous meningitis, fungal meningitis and viral meningitis: according to the history, clinical manifestations and different characteristics of cerebrospinal fluid changes, generally not difficult to identify, several common meningitis Cerebrospinal fluid identification points.
2. Differentiating from other non-central nervous system infections, cerebrovascular disease, especially subarachnoid hemorrhage; diabetic ketoacidosis; infection with toxic encephalopathy; intracranial space-occupying lesions, also relying on medical history, clinical manifestations, cerebrospinal fluid changes And imaging examination CT scan can be identified.
