meningite

Basic notitia

causa

1.Meningite purulenta

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

2.Tuberculousmeningitis

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

3.Viralmeningitis

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

4.Cryptococcalmeningitis

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

Fuscemanifestations

1.Tuberculousmeningitis

Manifestationum mutationes sunt in infantis animi, iracundie et clamoris; mentalis tristitiae; non placet ludi; potest etiam habere low-gradefever, damnum appetitum, vomitum, quietem dormire, pondus damnum.

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

2.Purulentmeningitis

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.

Examen

1.Laboratoryexamination

(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.Otherauxiliaryexaminations

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

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

Diagnosis

Inadditiontoclinicalmanifestationsandexaminations.Lumbarpunctureshouldbedonetodiagnosemeningitis.

Complicationes

Ifthetreatmentisimproper,thelesioncanbechangedfromacutetochronic,andthefollowingsequelaemayoccur:

1.Hydrocephalus

Duetomeningealadhesionsandcerebrospinalfluidcirculationdisorders;

2.Paralysisofcranialnervedamage

talis surdus, Visualimpairment, strabismus, facialnerve paralysis, etc.;

3.Cerebralvasculitiscauseslumenobstruction

causascerebralischemiaandinfarctionincorrespondingparts.

Curatio

Bacterialmeningitisisalife-threateningdiseaseandshouldbetreatedimmediately.Gototheemergencydepartmentimmediatelywhensymptomsappear.

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

Antibioticshavenoeffectonviralmeningitis,andantiviraldrugsshouldbeadded.

Praeventionis

1.Earlydetection, solitudo et tractatio.

2.Doagoodjobofhygienepromotionduringtheepidemic,trytoavoidlargegatheringsandgroupactivities,donotbringchildrentopublicplaces,andwearmaskswhengoingout.

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

4.Vaccineinjection.

Whydoesmeningitiscauseheadaches?

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