Pediatric meningococcal adrenal syndrome
Introduction
Introduction to pediatric meningococcal adrenal syndrome Meningococcal adrenal syndrome, namely, Waterhouse-Friderichsensyndrome, also refers to fulminant shock-type meningitis, also known as fulminant purpuric meningococcalemia, acute adrenal insufficiency, acute adrenal cortex Hypofunction, acute adrenal crisis, etc. basic knowledge The proportion of sickness: 0.0022% Susceptible people: children Mode of infection: non-infectious Complications: diffuse intravascular coagulation
Cause
Causes of pediatric meningococcal adrenal syndrome
Causes:
The cause of this syndrome is many, which can be induced by severe infection, bleeding, trauma, surgery, long-term use of large doses of hormones, and poor cortical stress response.
Pathogenesis:
In the past, the pathogenesis of this disease was considered to be a state of cortical failure caused by bilateral adrenocortical hemorrhage or embolism, which was considered to be a major or necessary factor in recent years. Toxins cause microcirculatory disorders, early small vasospasm, microcirculatory ischemia, decreased tissue perfusion, cell hypoxia and acidosis, clinical signs of mild shock, such as persistent hypoxia, accumulation of acidic metabolites, Most of the capillaries are dilated, a large amount of blood stagnates in the capillary bed, and the effective circulating blood volume is suddenly reduced, causing a series of severe shock symptoms. Due to the slow blood flow in the microcirculation, blood concentration, and accumulation of acidic products in the blood vessels, all can be triggered. Diffuse intravascular coagulation (DIC) makes microcirculatory pathway disorder, tissue hypoxia and acidosis aggravate, organ function declines, and shock is not easy to recover. After DIC, a large number of clotting factors are consumed, which causes patients to have bleeding tendency due to hypoxia. Increased plasmin, intravascular fibrinolysis, fibrinolysis Hyperthyroidism, vital organs microcirculation caused by tissue hypoxia ischemia, can cause heart, lung, kidney, liver dysfunction or failure, hypoxic brain edema.
Prevention
Pediatric meningococcal adrenal syndrome prevention
Take comprehensive preventive measures
Health education
During the epidemic period, we will do a good job in health education, carry out health and disease prevention publicity activities, do a good job in environmental and personal hygiene, maintain indoor air circulation, avoid children going to public places, and wear masks when going out.
2. Identify and control the epidemic in time
The patient should be isolated and treated for respiratory tract isolation until the symptoms disappear for 3 days or not less than 7 days after the illness. For healthy carriers or suspected patients, medication can be taken, often taking SMZco or SD, dose 12 years old, 1g / time, 2 times / d, and even served for 3 days. If it is not sensitive to SD, rifampicin 5 mg / (kg · d), 2 times / d, can be used for 2 days.
3. Specific immune prevention
It is an important measure to prevent cerebral circulation. Subcutaneous injection of purified capsular polysaccharide vaccine has been included in the planned immunization range, and the protection rate can reach 90%. It is usually injected every year from October to November, and can be strengthened once more in the following year.
Complication
Complications of cerebral meningococcal adrenal syndrome Complications, diffuse intravascular coagulation
DIC occurs, peripheral circulatory failure, etc.
Disseminated intravascular coagulation (DIC) is a syndrome, not an independent disease, with extensive fibrin deposition and platelet aggregation in capillaries, arterioles, and venules under various pathogenic factors. A wide range of microthrombus is formed. Lead to circulatory function and other visceral dysfunction, consumptive coagulopathy, secondary fibrinolysis, and clinical manifestations of shock, hemorrhage, embolism, hemolysis.
Symptom
Pediatric meningococcal adrenal syndrome symptoms Common symptoms Freckle pale pulsating pulse, rapid drowsiness, blood pressure, decreased blood pressure, shortness of breath, circulatory failure, no urine coma
The onset is urgent, the disease progresses rapidly, and the child appears in a wide range of defects throughout the body in a short period of time, and rapidly expands into a large ecchymosis. Symptoms of circulatory failure occur quickly. The early light manifestations are pale, lip circumference, limbs. Mild bun, mild skin and hair, cold hands and feet, rapid pulse, shortness of breath, decreased blood pressure, decreased urine output, conscious or lethargy, if not rescued in a timely manner, symptoms of peripheral circulatory failure increase, blood pressure drops significantly or not Out, the amount of urine is significantly reduced or no urine, and the mind is coma.
This type of sputum smear and blood culture are mostly positive, the meningeal irritation sign is more negative, and the cerebrospinal fluid can also be normal.
Cerebrospinal fluid examination: typical changes are pressure increase, appearance turbidity such as rice soup, the number of cells is significantly increased (1000 × 10 6 /L or more), mainly neutrophils, protein is increased, sugar and chloride content is reduced, septic patients Cerebrospinal fluid changes can be insignificant. C-reactive protein, lactic acid, immunoglobulin, lactate dehydrogenase (LDH) and its isoenzymes, sputum lysate test and TNF detection in cerebrospinal fluid are beneficial for diagnosis or prognosis.
Examine
Examination of pediatric meningococcal adrenal syndrome
1. The total number of white blood cells in the blood increased (15 ~ 40) × 10 9 / L, neutrophils > 0.80, also a small number of white blood cells are not high or decreased.
2. DIC and fibrinolysis test suspected of fulminant, should be dynamically detected to guide treatment, platelet progressive reduction, prothrombin time prolonged, fibrinogen reduction, 3P test and FDP test positive are DIC and secondary Indications for fibrinolysis.
X-ray chest X-ray, ECG and other examinations should be done.
Diagnosis
Diagnosis and diagnosis of cerebral meningococcal adrenal syndrome
1. Sudden onset.
2. Short-term appearance of ecchymosis throughout the body, and there is a rapid development trend.
3. With severe circulatory failure, the pulse is weak and fast, blood pressure drops significantly, pale, shortness of breath, cyanosis.
4. Freckle, blood, cerebrospinal fluid or blood culture positive.
The diagnosis must have 1, 2, and 3, and Article 4 can be used as evidence.
Identification with allergic purpura, the disease is dangerous, severe symptoms of poisoning, accompanied by peripheral circulatory failure and other symptoms, easy to identify.
