Pediatric aseptic meningitis syndrome
Introduction
Introduction to pediatric aseptic meningitis syndrome Aseptic meningitis syndrome (AMS), also known as serous meningitis, is a common clinical syndrome with meningeal irritation and mild or moderate increase in cerebrospinal fluid cells, but no bacteria found in cerebrospinal fluid. basic knowledge The proportion of illness: 0.02% Susceptible people: children Mode of infection: non-infectious Complications: cerebral edema, convulsions in children
Cause
Causes of pediatric aseptic meningitis syndrome
(1) Causes of the disease
Coxsackie virus and Echovirus are common pathogens of this disease. They have caused several pandemics around the world, followed by mumps virus, and a few other viruses, such as herpes simplex virus, lymphatic choriomeningitis virus, and insects. Vector virus, adenovirus, Epstein-Barr virus, in addition to Leptospira, acute bacterial infection, etc., Shanghai virus isolation and double serum test, in the clear pathogen of 79 cases of pediatric aseptic meningitis, Coxsackie virus And Echo virus caused 67 cases (Shanghai Medical University Pediatric Hospital, 1974), in 1960 Meyer et al studied 430 cases of aseptic meningitis, identified 305 cases of pathogens in Coxsackie virus and Echo virus 42%, polio accounted for 12%, mumps virus accounted for 22%, lymphocytic plexus meningitis virus accounted for 12%, a few were herpes simplex virus and leptospira.
Six types of Coxsackievirus B group, group A and many types of Echovirus can cause aseptic meningitis, including Coxsackie A7,9, Coxsackie B2,3,4, Echovirus 4,6,9,11,16,30 can cause epidemics, especially in the Ek 9 epidemic. All types of polio can cause aseptic meningitis, but its importance has been greatly reduced recently.
(two) pathogenesis
Viral meningitis is the result of systemic viral infection spread to the central nervous system via bloodstream. Some viruses mainly infect meninges, choroid plexus and ependymal membrane without infection of brain parenchyma cause meningitis; others tend to Infected with neurons and glial cells, so it causes encephalitis. In fact, the two infections cannot be separated and overlap.
Prevention
Pediatric aseptic meningitis syndrome prevention
Do a good job in various vaccination work; actively prevent respiratory and digestive tract infectious diseases; strengthen nutrition, enhance physical fitness, and improve disease resistance.
Complication
Pediatric aseptic meningitis syndrome complications Complications, brain edema, convulsions in children
In severe cases, it can cause convulsions, abnormal mental changes, and cerebral edema.
Symptom
Pediatric aseptic meningitis syndrome symptoms common symptoms anorexia sore muscles meningitis meningitis abdominal pain meningeal irritation nausea fever
The symptoms can occur all year round, more in summer and autumn, with the majority of children, the onset can be slow, accompanied by anorexia, nausea, vomiting, abdominal pain, headache, sore throat, myalgia and other symptoms, fever is generally moderate, On average, 4 to 6 days of heat retreat, sometimes retreat and can be restarted, showing a biphasic heat type, most of the symptoms of meningeal irritation within 1 to 2 days, but often less than purulent meningitis.
Examine
Examination of pediatric aseptic meningitis syndrome
The number of cells in cerebrospinal fluid is generally between 100 and 200, and occasionally up to 1000 or more. In the beginning, neutrophils are more, in the later stage, mononuclear cells are more, sugar and chloride are normal, protein is slightly increased, and culture is free of bacteria. The peripheral blood leukocytes are normal or slightly higher, brain CT, brain B-ultrasound, etc., can be found in brain edema and other changes.
Diagnosis
Diagnosis and diagnosis of aseptic meningitis in children
In the onset season, epidemiology and certain conditions can provide diagnostic clues, such as aseptic meningitis and skin maculopathy may be Echovirus infection, while epidemic myalgia may be Coxsackie virus B infection, determine Diagnosis depends on virology and serological examination, cerebrospinal fluid, pleural effusion, ascites, and the virus is isolated from the blood. The virus isolated from the stool or pharyngeal secretion must be combined with the increase of serum antibody titer to diagnose the disease. Blood samples were taken twice a week for 2 to 3 weeks for serum antibody determination. If the titer is more than 4 times higher, it has diagnostic significance.
Mumps virus is second only to enterovirus in the pathogen of aseptic meningitis, which is the second place. When there is no parotid gland enlargement, the symptoms are similar and cannot be identified clinically. Generally, mumps meningitis or encephalitis More common in winter and spring, there is a history of contact with mumps, increased blood amylase, and parotid gland enlargement is a strong evidence for the diagnosis of mumps, but mumps virus infection does not all have parotid swelling, while Coxsackie virus and Echo Viral infection, Japanese encephalitis has been reported to be complicated by parotid swelling.
In general, the symptoms of Japanese encephalitis are heavier than the symptoms of enterovirus infection and last for a long time, but the difference is relative. The symptoms of Japanese encephalitis are very light, and the enterovirus may have severe encephalitis. symptom.
This symptom should be distinguished from tuberculous meningitis and suppurative meningitis treated with incomplete antibiotics.
