Streptococcus pneumoniae meningitis in children
Introduction
Introduction to pneumococcal meningitis in children Streptococcus pneumoniae meningitis is more common in infancy, and neonates can also develop disease. The incidence of Streptococcus pneumoniae meningitis is second only to epidemic cerebrospinal meningitis, often secondary to upper respiratory tract infection, otitis media, pneumonia, sinusitis, mastoiditis, sepsis and craniocerebral trauma. basic knowledge The proportion of illness: the probability of illness in infants and young children is 0.003% Susceptible people: infants and young children Mode of infection: non-infectious Complications: hydrocephalus cerebral infarction brain edema cerebral palsy
Cause
Causes of pneumococcal meningitis in children
Causes:
The pathogen is Streptococcus pneumoniae. There are 83 kinds of serotypes. Type I, II and III are highly pathogenic. The other types are weak or non-virulent, mostly upper respiratory parasites. Pneumococcal is warhead-shaped. The diameter is about 0.5 to 1.5 m. When it is arranged in double, the blunt end or the tip is opposite, sometimes arranged in a short chain or in a single shape, and a capsule can be formed in the body. In the ordinary stained specimen, since the capsule is not easy to be colored, it appears The non-colored translucent shadow surrounds the periphery of the bacteria. This capsule can be dyed by special staining method to help identify. Streptococcus pneumoniae does not produce exotoxin. Its pathogenicity mainly depends on the capsule invasion. After infection, the body can be obtained. Short-term immunity, easy to relapse, recurrence, and a variety of bacterial types, short immunization period.
Pathogenesis:
Pus and adhesions are concentrated on the surface of the brain. There are many tops, like caps, and there are fewer pus in the brain. The lesions in the late stage are more common and serious. Common complications include subdural effusion or empyema. It can cause the ventricles to expand and even form hydrocephalus.
Prevention
Prevention of Streptococcus pneumoniae meningitis in children
1. purulent meningitis
(1) Active prevention of respiratory infections: Less contact with patients with respiratory infections, usually establish a good living system, indoor open windows ventilation, carry out necessary outdoor activities, enhance physical fitness.
(2) Passive immunization: At present, imported influenza bacillus vaccine is applied domestically.
2. Streptococcus pneumoniae infection
Multivalent S. pneumoniae polysaccharide vaccine injection prevention can be used.
Complication
Pediatric pneumococcal meningitis complications Complications hydrocephalus cerebral infarction brain edema cerebral palsy
The disease is often caused by serious illness, late diagnosis or improper treatment, such as subdural effusion, empyema or hydrocephalus, severe cerebral infarction, cerebral emphysema, cerebral edema, cerebral palsy and so on.
Symptom
Pediatric pneumococcal meningitis symptoms common symptoms meningeal irritation bacterial infection meningitis brain abscess bacterial endocarditis hydrocephalus secondary infection convulsions coma skull fracture
In the epidemic season of pneumonia, meningeal irritation occurs.
Meningeal irritation
To be proficient in the above-mentioned clinical manifestations of infantile brain, it is worth pointing out that shortly after the onset of pneumococcal meningitis, coma and convulsions are prone to occur. Suspicious cases should be promptly lumbar puncture for examination of cerebrospinal fluid, severe or advanced cases, intraspinal The pus is sticky and not easy to flow out. If the needle tip has entered the spinal cavity during lumbar puncture, the cerebrospinal fluid does not flow out. It can be washed repeatedly with a small amount of normal saline, and the washing liquid is routinely examined and cultured. In some cases, the degree of cerebrospinal fluid turbidity is not serious. Even a little bit sputum, the number of cells is only a few hundred, but a large number of pneumococci can be seen in the smear staining. This situation should be regarded as a serious condition, and treatment must be taken seriously. The Danish Serum Institute is the only one in the world that produces a full set of serum. The unit, Omni serum includes type 83, which can be used for antigen detection, but type 7, 14 cannot be detected by CIE method, LA, CoA method can detect all S. pneumoniae.
2. Other features
In addition to the clinical manifestations of suppurative meningitis described above, there are also the following characteristics:
(1) The condition is heavier: the patient's condition is generally heavier, prone to frequent convulsions, and severe coma.
(2) The course of disease is prone to prolongation: the course of disease is prone to prolongation and repeated recurrence.
(3) common complications: subdural effusion, empyema, brain abscess, hydrocephalus.
(4) cranial nerve damage: cranial nerve damage accounted for 50%, often involving the oculomotor nerve, facial nerve.
(5) Pathogen detection: In some cases, the degree of cerebrospinal fluid opacity is not serious, even a little sputum, the number of cells is only a few hundred, but a large number of S. pneumoniae can be seen under the smear staining microscope, indicating that the disease is severely manifested, and no bacteria are found. In the case, the detection of S. pneumoniae-specific DNA by PCR can confirm the diagnosis.
3. Easy to relapse or re-issue
Another characteristic of pneumococcal meningitis is that it is easy to relapse or relapse many times. It can occur several times, dozens or even dozens of times. Huaxi Medical University has seen a case of recurrence of about 100 times, thus preventing and stopping this situation. The occurrence is very important, and there are three main factors that cause recurrence or recurrence:
(1) Incomplete treatment: The first time the disease is not completely cured, there are some small suppurative foci in the skull. When the resistance is low, it can cause meningitis.
(2) Congenital defects: including:
1 congenital immune function is low.
2 congenital skin-like sinus: common in the head occipital or lumbar, the midline of the back, and coexisting with the recessive spina bifida, can also have a spinal canal endothelial or epithelial congenital mass, this sinus is more common in the waist The axillary part, the local soft tissue can be slightly raised, the skin around the small hole of the sinus can be seen with pale red pigmentation, and there are bundles of hair, occasionally fine hair protrudes from the small hole, sometimes a little liquid seeps out, when secondary infection Local redness, swelling, and pain.
3 meninges or spinal cord bulging.
4 congenital persistent rock scales.
5 congenital sieve plate defects.
(3) Acquired injuries: including:
1 skull fractures are more common, sometimes linear fractures, X-ray photography does not necessarily see, dural tears and cerebrospinal fluid ear effusion or nasal overflow, the presence of nasal overflow can be equal to the sugar content of the nasal secretions and cerebrospinal fluid sugar, or Injecting dyes such as blush 2ml from the spinal canal can be confirmed in the nasal cavity, and the radionuclide scan can help diagnose.
2 head facial surgery or bronchial damage caused by osteoma.
3 Chronic inflammation of the nose or ear and pathogenic bacteria such as bacterial endocarditis continue to invade the dura mater.
4 After the spleen is cut, the immune function is low.
The pathogen of each recurrence is still pneumococcal. Whether it is sometimes different in type or not reported in the literature, it may also cause recurrence of meningitis caused by other bacterial infections. At this time, bacteria often directly invade the meninges, and the onset is generally rapid, clinical manifestations. Similar to the initial episode, because the family members of the sick child have certain experience, they can seek medical treatment in time and are easy to cure. The key to treating such sick children is thorough treatment and careful identification of the causes of recurrence, and fundamental solutions, such as clearing all congenitals as much as possible. And acquired defects and injuries.
Examine
Examination of pneumococcal meningitis in children
Cerebrospinal fluid examination
In severe or advanced cases, the pus in the spinal canal is sticky and not easy to flow out. If the needle tip has entered the spinal cavity during lumbar puncture, the cerebrospinal fluid does not flow out. It can be washed repeatedly with a small amount of normal saline, and the washing liquid is routinely examined and cultured. Some Cases of cerebrospinal fluid opacity is not serious, even a little sputum, the number of cells is only a few hundred, but a large number of S. pneumoniae (suggested by severe smear) can be seen under the smear staining microscope.
2. Antigen detection
In the absence of bacteria, the detection of S. pneumoniae-specific DNA by PCR can confirm the diagnosis. The Danish Serum Institute is the only unit in the world that produces a full set of serum. Omni serum includes type 83, which can be used for antigen detection, but Types 7, 14 cannot be detected by the CIE method, and the LA, CoA method can detect all S. pneumoniae.
3. Blood examination
Peripheral blood has a significant increase in white blood cells and neutrophils.
Should be X-ray, B-ultrasound, brain CT and other examinations.
Diagnosis
Diagnosis and diagnosis of pneumococcal meningitis in children
diagnosis
According to the clinical manifestations and laboratory findings, shortly after the onset of pneumococcal meningitis, suspected cases of coma and convulsions should be checked for cerebrospinal fluid in the lumbar puncture. Cerebrospinal fluid smear sees a large number of pneumococci, and treatment must be taken seriously.
Differential diagnosis
Recurrent pneumococcal meningitis should be differentiated from Mollaret meningitis. Mollaret meningitis is a rare disease of unknown etiology. It is characterized by benign recurrence. The youngest age of adolescents is 5 years old. It is characterized by episodic fever and headache. , vomiting, neck stiffness, Klinefelter and Brine's sign positive, sometimes with epileptic seizures, syncope, coma, transient vision, language barriers, temporary facial paralysis, diplopia, pupils, etc., sudden onset of symptoms The peak is reached in a few hours, each time lasts for a short time. After about 3 to 7 days, the symptoms suddenly disappear. There are no abnormalities during the two episodes. The cerebrospinal fluid is purulent, the protein is increased, the sugar is slightly reduced, the white blood cells are obviously increased, and the sera stain is large. Mononuclear cells, ie, Mollaret cells, which are about 4 to 5 times larger than normal monocytes, have unclear cell membranes, are mostly gray in cytoplasm, have no vesicles in vacuoles, have pits in the nucleus, some have lobes, no In nucleolus, after 1 to 2 days, the cerebrospinal fluid is mainly lymphocytes, and the bacteria, fungi, and virus tests are all negative. The large number of Mollaret cells detected is an important basis for the diagnosis of this disease, but It must be differentiated from tumor cells. Tianjin Children's Hospital reported a 13-year-old girl in 1980 and repeated 7 times in 4 and a half years.
