meningitis
Introduction
Introduction Meningitis is a disease in which a delicate meninges or meninges (a membrane between the skull and the brain) are infected. The disease is usually accompanied by a bacterium or virus that infects any part of the body, such as an ear, sinus or upper respiratory tract infection. Bacterial meningitis is a particularly serious disease that requires timely treatment. If the treatment is not timely, it may die within a few hours or cause permanent brain damage. Viral meningitis is more serious but most people can recover completely, with a few legacy sequelae. Meningitis is relatively rare. In the United States, there are fewer than 3,000 cases per year, most of which are infants under two years of age. The initial symptoms are similar to colds, such as fever, headache and vomiting, followed by drowsiness and neck pain, especially when stretching forward. Children often feel pain when they have a bow back. JE will have dark red or light purple spots covering the whole body. In children, the cranial pressure caused by encephalitis causes the cardia to protrude (the soft place where the baby's head bones are not seamed). Meningitis can be transmitted in people living together, such as in a student residence. Meningitis, especially bacterial meningitis, rarely occurs. Although the outbreak has increased since 1991, it has not been clear why.
Cause
Cause
Spread by coughing or sneezing. Some studies have shown that people are most likely to be infected by germs when they have a cold, because it is extremely easy to get bacteria into the skull because of the inflammation of the nose.
Tuberculous meningitis is a non-suppurative inflammation of the meninges caused by Mycobacterium tuberculosis, accounting for about 6% of systemic tuberculosis. Mycobacterium tuberculosis infection is disseminated by blood and then implanted under the pia mater to form tuberculous nodules. After nodule rupture, a large number of tuberculosis bacteria enter the subarachnoid space. In recent years, the incidence and mortality of tuberculous meningitis have increased. Early diagnosis and treatment can improve efficacy and reduce mortality.
Viral meningitis can be caused by several viruses, including several diarrhea-related viruses, one of which may be infected by bites such as voles.
Cryptococcal meningitis: can also be caused by fungi. The most common one is cryptococcus, which can be found in pigeons. Healthy people are not susceptible to fungal-associated meningitis, but different from those infected with HIV, a human immunodeficiency virus that causes AIDS.
Examine
an examination
Diagnosis of meningitis should be done by lumbar puncture. In order to alleviate the pain caused by this operation, it should be performed after anesthesia in the hospital. Use a needle to puncture a sample of cerebrospinal fluid between the two bones on the spine. If the clear cerebrospinal fluid becomes cloudy or has purulent cells, it should be suspected of meningitis, and special culture tests will be required. Blood samples, urine samples, and eye and nasal secretions will be collected. Because the disease develops rapidly, treatment should be carried out immediately, even before the results of the test.
Diagnosis
Differential diagnosis
The diagnosis should be differentiated from the following symptoms:
1. Suppurative meningitis: The most confusing one is Haemophilus influenzae meningitis. Because it is more common in children under 2 years old, the number of cerebrospinal fluid cells is sometimes not very high. Followed by meningococcal meningitis and pneumococcal meningitis. Identification of the history of tuberculosis exposure, tuberculosis and pulmonary X-ray examination can help diagnose, the important thing is the cerebrospinal examination, in the case of higher than the number of cells, the important thing is cerebrospinal fluid examination, the number of cells is higher than 1000 × 106 / L (1000/mm2), and when the majority of neutral polymorphonuclear granulocytes in the classification, suppurative meningitis should be considered, but more important is cytology.
2. Viral central nervous system infection: mainly viral encephalitis, viral meningoencephalitis and viral myelitis can be confused with the brain, and the viral encephalitis that is emitted needs to be identified more than the epidemic. The diagnostic points of various viral meningitis are:
1 There are often specific seasons.
2 each has its own special systemic manifestations, such as enteroviruses may be associated with diarrhea, rash or myocarditis.
3 cerebrospinal fluid changes in addition to cell number and classification and brain is not easy to identify, biochemical changes are not the same, viral meningoencephalitis cerebrospinal fluid sugar and chloride normal or slightly higher, protein is not obvious, more than 1g / L (100mg / Dl). 4 Various viral encephalitis or meningitis have their own specific laboratory diagnostic methods, such as serological examination and virus isolation (see related sections).
Light virus encephalitis and early brain identification are more difficult, the principle of treatment is:
1 First use anti-tuberculosis drugs, and at the same time carry out various tests, such as lignin test, lung X-ray film, etc. to assist in diagnosis.
2 no hormone treatment, such as short-term recovery of normal cerebrospinal fluid is viral encephalitis rather than brain.
3 no injection of any drugs in the sheath, so as not to cause changes in the composition of the cerebrospinal fluid to increase the difficulty of differential diagnosis.
3. Cryptococcus neoformans meningoencephalitis: its clinical manifestations, chronic course of disease and cerebrospinal fluid changes can be similar to the brain, but the course of disease is longer, with spontaneous relief. Chronic progressive intracranial hypertension is more prominent, and other manifestations of meningitis are not equal. The disease is rare in infants and young children, so it is easy to be misdiagnosed as the brain. The smear was confirmed by cerebrospinal fluid smear, and the cryptococcal spores with round and thick capsules were observed by black staining with ink. The cryptococcal growth was observed on the sand-protecting medium.
4. Brain abscess: Children with brain abscess have a history of otitis media or head trauma, sometimes secondary to sepsis. Often accompanied by congenital heart disease. In addition to meningitis and high intracranial pressure symptoms, children with brain abscess often have focal brain signs. Cerebrospinal fluid changes in the absence of secondary purulent meningitis, the number of cells can range from normal to hundreds, mostly lymphocytes, sugar and chloride are normal, protein is normal or increased. Differential diagnosis by means of ultrasound, EEG, brain CT and cerebral angiography.
5. But the difference between brain tumor and brain is:
1 less fever.
2 convulsions are less common, even if there is convulsions, most of them are conscious after pumping, and children with advanced cerebral palsy are in a coma after convulsions.
3 coma is less common.
4 high intracranial pressure symptoms and brain signs are not parallel.
5 Cerebrospinal fluid changes are little or slight. 6 The test was negative and the lungs were normal. For the diagnosis of brain tumors, brain CT scans should be performed in time to assist in diagnosis.
Typical brain diagnosis is easier, but some are atypical, and diagnosis is difficult. There are several situations in atypical brains:
1 Infants and young children have an acute onset, and they are progressing rapidly. Sometimes they can be convulsed as the first symptom.
2 early symptoms of brain parenchymal damage, manifested as chorea or mental disorders.
3 early cerebrovascular damage, manifested as limb paralysis.
4 When combined with brain tuberculoma, it can be like intracranial tumor manifestations.
5 other parts of the tuberculosis lesions are extremely serious, can mask the symptoms and signs of meningitis and are not easy to identify.
6 When meningitis occurs during anti-tuberculosis treatment, it often appears to be frustrated. For the above various atypical scales, the diagnosis needs to be particularly careful to prevent misdiagnosis.
Diagnosis of meningitis should be done by lumbar puncture. In order to alleviate the pain caused by this operation, it should be performed after anesthesia in the hospital. Use a needle to puncture a sample of cerebrospinal fluid between the two bones on the spine. If the clear cerebrospinal fluid becomes cloudy or has purulent cells, it should be suspected of meningitis, and special culture tests will be required. Blood samples, urine samples, and eye and nasal secretions will be collected. Because the disease develops rapidly, treatment should be carried out immediately, even before the results of the test.
