meningitida

Základní informace

Způsobit

1.Purulentní meningitida

Meningealinflammationcausedbyvariouspyogenicbacteriaisalargecategoryofbacterialmeningitis.Itisoneoftheseriousintracranialinfections,oftenaccompaniedbypurulentencephalitisandbrainabscess.Thecommonpathogenicbacteriaare3types,namelyHaemophilusinfluenzaetypeB,Neisseriameningitidis(Diplococcus)andStreptococcuspneumoniae(Streptococcuspneumoniae).Usuallyasmallnumberofhealthypeoplecarrythesegermsinthenoseoronthebodyanddonotharmthehumanbody.Theyarespreadthroughcoughingorsneezing.Peoplearemostlikelytobeinfectedbygermswhentheyhaveacold,becauserhinitismakesitextremelyeasyforbacteriatoentertheskull.

2.Tuberkulózní meningitida

Itisanon-purulentinflammationofthemeningescausedbyMycobacteriumtuberculosis.Itaccountsforabout6%ofsystemictuberculosisandisthemostcommoncentralnervoussystemtuberculosis.Itisnotonlythemostserioustypeoftuberculosis,butalsotheleadingcauseofdeathfromtuberculosisinchildren.AftertheinfectionofMycobacteriumtuberculosisisspreadthroughtheblood,itisplantedunderthepiamatertoformtuberculosisnodules.Afterthenodulesareruptured,alargenumberoftuberculosisbacteriaenterthesubarachnoidspace.Inrecentyears,theincidenceandmortalityoftuberculousmeningitishaveincreased.Earlydiagnosisandtreatmentcanimproveefficacyandreducemortality.

3. Viralmeningitida

Itisaninfectionofthecentralnervoussystemcausedbyavarietyofviruses.Virusesthatcancausemeningitisincludearbovirus,enterovirus,Echovirus,poliovirus,CoxsackievirusAandB,Echovirus,myxovirusandparamyxovirus,herpesvirus,arenavirus,etc.Followedbymumpsvirus,herpessimplexvirusandadenovirus.Virusesofteninvadethebrainparenchymaandshowmeningoencephalitis,whichisclassifiedasasepticmeningitis.

4. Kryptokoková meningitida

Mingingitiscanalsobecausedbyfungi.ThemostcommononeisCryptococcus,whichcanbefoundinpigeonfeces.CryptococcalmeningitisisadeepfungalinfectioncausedbycertainspeciesorvariantsofCryptococcusinvadingthecentralnervoussystem.Healthypeoplearenotsusceptibletofungus-relatedmeningitis,butitisdifferentforthoseinfectedwiththeHIVvirus.CryptococcalmeningitiscanoccurafterinfectionwithCryptococcus.

Klinické projevy

1.Tuberkulózní meningitida

Rané projevy jsou změny v duševním stavu dítěte, jako je podrážděnost a pláč; mentální pomalost; nemají rádi hry; mohou mít také nízkou horečku, ztrátu chuti k jídlu, zvracení, neklidný spánek, hubnutí.

Olderchildrencancomplainofheadaches.Iftheconditionissevere,theheadacheispersistentandaggravated,vomitingcanbeaggravatedandcanbecomejet,drowsinessgraduallyappears,andconvulsionsmayoccur.Iftheconditionisfurtheraggravated,coma,frequentconvulsions,looselimbs,andparalysismayoccur.Irregularbreathingmayalsooccur,andsomechildrendie.

2.Purulentní meningitida

Itiscommoninchildrenandtheelderly,causedbyvariouspurulentbacteriaMeningealinflammation.Themainmanifestationsarefever,headache,vomiting,irritabilityandothersymptoms.Nervoussystemexaminationandcerebrospinalfluidexaminationareabnormal.Duetotheweakresistanceofchildrenandtheimperfectdevelopmentoftheblood-brainbarrier,bacteriacaneasilyenterthecerebralnervoussystem.Generally,sepsisiscausedbyinfectioninotherpartsofthebody,andbacteriaenterthebrain.Partlyduetoinfectionafterotitismediaandheadtrauma,bacteriadirectlyenterthemeninges.

Inchildhood,theonsetisrapid,withhighfeverreachingabove39℃.Childrenoftencomplainofsevereheadache,poorspirits,fatigue,lossofappetite,andfrequentvomiting.Attheonsetoftheillness,thechildisconsciousanddrowsiness,confusion,disorganizedspeech,inabilitytodistinguishthedirectioncorrectly,convulsions,andcomamayoccurintheprogressofthedisease.Inseverecases,convulsionsandcomaappearwithin24hoursaftertheonsetofillness.Ifitisnottreatedintime,theconditionprogresses,theneckisstiff,theheadistiltedback,thebackisstiff,andthewholebodybendsbacklikea"bow",whichismedicallycalledreflex.Irregularbreathingmayalsooccur,andevenrespiratoryfailuremayoccur,andsomechildrenhavebleedingspotsontheskin.

Becausethelesionscancausemeningealadhesionsandbrainparenchymaldamage,cranialnervepalsy,blindness,hearingimpairment,limbparalysis,epilepsy,andmentalretardationcanoccur.

Zkouška

1.Laboratorní vyšetření

(1)BloodpicturePeripheralbloodpicturewhitebloodcellsinacutephaseThecountissignificantlyincreased,andimmaturecellsmayappearmainlyduetoneutrophils.

(2)CerebrospinalfluidIncreasedpressure,turbidandpus-likeappearance,whitebloodcellcountbetween1000～10000/mm,higherinafewcases,mainlyneutrophils,butItaccountsformorethan90%ofthetotalnumberofwhitebloodcells.Sometimestheaccumulationofpuscellsislumpy.Atthistime,thesmearandthecultureofpathogenicbacteriaaremostlypositive.Occasionally,thefirstlumbarpuncturewasnormal,anditbecamepurulentafterafewhours.Theproteinincreases,upto1.0g/Lormore,thesugarcontentdecreases,usuallylessthan2.2mmol/L,thechloridecontentalsodecreases,andtheimmunoglobulinIgMandIgGincreasesignificantly.

(3)BacterialantigendeterminationCommonlyusedmethodsincludepolymerasechainreaction,convectionimmunoelectrophoresis,latexagglutinationtest,enzyme-linkedimmunosorbenttest,radioimmunoassay,etc.

(4)Otheroptionaltestsinclude:hematuria,bloodelectrolytes,bloodsugar,liverandkidneyfunction.

2.Ostatní pomocná vyšetření

(1)X-rayradiographyChestX-rayisparticularlyimportantforpatientswithpurulentmeningitis,Canfindpneumonialesionsorabscesses.Craniocerebralandsinusplainfilmcanfindskullosteomyelitis,sinusitis,mastoiditis,buttheCTexaminationoftheabovelesionsisclearer.

(2)CTandMRIexaminationsEarlyCTorcranialMRIexaminationsofthelesioncanbenormal.Whenthereareneurologicalcomplications,abnormalmanifestationssuchasenlargementoftheventricles,narrowingofthesulcus,swellingofthebrain,andshiftingofthebraincanbeseen.Andcanfindependymitis,subduraleffusionandlocalizedbrainabscess.EnhancedMRIscanismoresensitivetothediagnosisofmeningitisthanenhancedCTscan.MRIscanscanshowmeningealoozingandcorticalreactions.Withappropriatetechnicalconditions,itcanshowvenousocclusionandinfarctionofthecorrespondingpart.

Diagnóza

Inadditiontoclinicalmanifestationsandexaminations.Lumbarpunctureshouldbedonetodiagnosemeningitis.

Komplikace

Ifthetreatmentisimproper,thelesioncanbechangedfromacutetochronic,andthefollowingsequelaemayoccur:

1.Hydrocefalus

Duetomeningealadhesionsandcerebrospinalfluidcirculationdisorders;

2.Paralýza poškození kraniálních nervů

jako je hluchota, zrakové postižení, strabismus, paralýza obličejových nervů atd.;

3.Cerebrální vaskulitida způsobující obstrukci slumen

Způsobitscerebralischemiaandinfarctionincorrespondingparts.

Léčba

Bacterialmeningitisisalife-threateningdiseaseandshouldbetreatedimmediately.Gototheemergencydepartmentimmediatelywhensymptomsappear.

Thetreatmentofbacterialmeningitisismainlytofindbacteriabasedoncerebrospinalfluidsmearsandculture,selecteffectiveantibioticsbasedondrugsensitivitytests,andtreatthemintimetoreducetheoccurrenceofsequelae.Itisnecessarytotreathighfeversymptomatically,controlconvulsions,reduceintracranialpressure,reducecerebraledema,andusehormonestoreduceintracranialinflammationandadhesion.

Antibioticshavenoeffectonviralmeningitis,andantiviraldrugsshouldbeadded.

Prevence

1. Včasná detekce, izolace a léčba na místě.

2.Doagoodjobofhygienepromotionduringtheepidemic,trytoavoidlargegatheringsandgroupactivities,donotbringchildrentopublicplaces,andwearmaskswhengoingout.

3.Duringepidemicsofmeningococcaldisease,anyonewhohasfeverwithheadache;malaise;acutepharyngitis;skinandoralmucosalhemorrhagecanbeusedforsymptomaticpreventivetreatmentwithdrugs,whichcanbeeffectiveToreducetheincidencerateandpreventtheepidemic.

4.Injekce vakcíny.

Proč meningitida způsobuje bolesti hlavy?

Mingingitiscanbedividedintomanytypes.Accordingtothecause,itcanbedividedintocommonbacterial,tuberculosis,viral,fungal(mold),meningealcancer,etc.,andacutemeningitisaccordingtothespeedofonsetInflammation,suchascommonbacterialandviralinfections,ismostlyacute;chronicmeningitisismorecommonintuberculousorfungalinfections.Themainclinicalmanifestationsofacutepatientsarefever,headache,andneckandoccipitalstiffness.Forchronicpatients,headacheisthemaincause.Meningitisreferstosurroundingthebrainandspinalcord...

ChiefphysicianHuangYining,PekingUniversityFirstHospital,DepartmentofNeurology,comesfrom:EncyclopediaFamousMedicalNetwork

Suddenlyhaveahighfever,headache,Whatdiseaseshouldbeconsideredforvomiting?

Headache,nauseaandvomitingarealsocommonsymptomsofinfection.Whenhighfever,chills,headache,andvomitingareaccompaniedbyneckstiffness,andheadacheworsenswhentheheadislowered,thepossibilityofacutemeningitisshouldbehighlysuspected,andthehospitalshouldbeconsultedintime.Acutemeningitisisfierceandthemortalityrateishigh.Epidemicmeningitiscausedbymeningococcusiscommon,referredtoasmeningococcalmeningitis,andmeningitiscausedbypneumococcusisalsomorecommon.Thesepatientsoftenhavecold-likemanifestationsinthedaysbeforetheonset...

ChiefphysicianHuangYining,PekingUniversityFirstHospital,DepartmentofNeurology,from:EncyclopediaFamousMedicalNetwork