Meningococcal Meningitis - PDF by fdjerue7eeu

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									Meningococcal Meningitis
Epidemic cerebrospinal meningitis (epidemic cerebrospinal meningitis)
referred to as meningitis. Is caused by the meningococcal purulent
meningitis. Clinical manifestations were fever, headache, vomiting,
skin mucous membrane petechiae, ecchymosis, and neck stiffness and
other meningeal irritation.
The disease was described in 1805 by the Swiss Vieusseaux. 1887
Weichselbaum isolated from the cerebrospinal fluid of meningococcal.
Tao of China in 1896, official report in Wuchang.
[Edit this paragraph] [etiology]
Neisseria meningitidis is a genus, gram-negative, kidney-shaped, and
more arranged in pairs, or four linked. Higher nutritional
requirements of bacteria by blood or chocolate agar medium at 37 ¡æ,
with 5 ~ 10% CO2, pH7.4 environment, easy to grow. Passage 16 ~ 18
hours of bacterial growth strong, the strongest antigenicity.
Autolysis of the bacteria with enzymes, such as timely vaccination is
not easily dissolved death. To cold, dry sensitive, less than 35 ¡æ,
heated to 50 ¡æ or general disinfectants are easily to death.
According to the strains of different capsular polysaccharide antigens
by hemagglutination test to the bacteria into A, B, C, D, X (1916), Y
(1889), Z, W135 (319), 29E (1892), H, I, K and L13 sera groups. To A,
B, C group is more common. Meningococcal bacteriocins (meningocin) can
also be divided into 4 groups A, C Group is divided into 6 types; B
group is divided into 11 types, including type 2 pathogenicity of
group B the strongest. According to their lipopolysaccharide (CPS)
will be divided into 8 meningeal meningitis immunization LPS type, and
pathogenic relationship is unclear.
The past 20 years some European and American countries, the prevalence
of bacteria from group A into B group and C group; flora is mainly
popular in China A group, B group only a few. But the carriers to B, C
group based in the future will become a major popular flora, to be
closely observed.
From the 60 years since the meningococcal resistance to the sulfa
increasingly common phenomenon, particularly in the C group and B
group of the most serious. A group of drug resistance, as different
countries and region to region, but also an increasing trend. The
epidemic strain isolated in China are mostly sensitive to the
sulfonamides, it is a sulfa drug treatment of the disease one of the
main drug.
[Edit this paragraph] [Epidemiology]
(A) the source of infection is the carriers and patients. Patients
from the beginning to the end of incubation period of infectious
disease within 10 days. Patients or carriers of pathogens present in
nasopharyngeal secretions, by droplets. During the epidemic, a disease
with two or more accounted for 2 to 4%, but the crowd often
nasopharyngeal carrier rate was significantly higher, sometimes up to
50% or more, people carrier rate of more than 20% of the popular tips
may occur, so carriers as a source of infection more meaningful.
(B) the transmission of pathogenic bacteria by coughing, sneezing,
talking, etc. directly from the air by the droplets spread in vitro
viability of their very weak, so indirectly through the everyday
little chance of transmission. Close contact, like sleep, arms,
breastfeeding, kissing babies under the age of 2 is important to
spread the disease.
(C) people of any age may be the disease susceptibility, from 2 to 3
months beginning 6 months to 2 years the highest incidence rates,
after declining with age. Bactericidal antibody from maternal neonatal
morbidity so rare. Carriers and patients in the blood after infection
and bactericidal antibody IgG, IgM, IgA increased, the antibody in
addition to a bactericidal effect with the group of pathogens, the
different groups of meningococcus has bactericidal effect, which is
due to the various groups of bacteria the existence of common outer
membrane protein antigens. Latent infection acquired through the group
of lower antibody titers, only protect the body from disease, not
prevent re-infection.
(D) 1 year before onset of epidemic characteristics began in November
the following year peak of 3,4 month, May began to decline. Other
seasons there are a few sporadic cases occur. As the crowd to
decreased immunity, the accumulation of susceptible persons, in the
past usually occur every 3 to 5 years in a small pop, 8 to 10 years,
once a pandemic. Factors and more popular indoor activities, poor
ventilation, lack of sunlight, overcrowding, risk of respiratory viral
infections and so on.
Medium and small cities in 2 to 4 years or 5 to 9 years of age the
highest incidence rates, male and female incidence rates are
approximately equal. Cities spread disease. Once the source of
infection involved in the remote mountainous areas, often caused by
point-like outbreak, more than 15 years of age the incidence of
disease by more than half of the total. A more than 2 or 2 disease
Zheyi common.
Dominant infection and latent infection ratio of approximately 1:1000
to 5000.
[Edit this paragraph] [pathogenesis and pathological changes]
(A) of the pathogenesis of Neisseria meningitidis from the nasopharynx
into the human body, its development depends on interactions between
human pathogens. If the human health and the immune system normal, you
can quickly destroy bacteria or become carriers. If the body lacks the
specificity of bactericidal antibody, or a strong poisonous bacteria,
the bacteria invade the bloodstream from the nasopharynx, the
formation of bacteremia or sepsis. Membrane formation and then
invasive suppurative cerebrospinal meningitis.
Congenital or acquired now that lack or reduction of IgM, C3 or C3 ~
C9 lack of easy to cause disease, recurrent or was even fulminant,
also suggested that bacteria-specific IgA increased with the formation
of immune complexes is the factors that cause disease.
Over the past that outbreaks of sepsis syndrome type called China a Fr
(Waterhuose-Friderichsen syndrome), is due to adrenal hemorrhage and
necrosis caused by acute adrenal failure caused. Recent studies
suggest that mainly due to meningococcus in the capillary endothelial
cells multiply rapidly releasing endotoxin, due to microcirculation
and activate the coagulation system causes DIC. LPS also activated
both humoral and cell-mediated response system, the occurrence of
generalized Schwarzman reaction (Shwartzmans reaction). Schwarzman
adrenocortical response to hemorrhage is the result of the body.
Microcirculation in the body and internal organs such as the system,
the clinical manifestations of an outbreak of sepsis; as to the
formation of cerebral vascular injury is the main type of meningitis;
or a combination of the so-called mixed type.
Patterns of chronic sepsis and recurrent chronic causes, in addition
to the formation of acute lack of bactericidal antibody after
infection, its complement system C6, C7 defects may also be an
important reason.
(B) of the pathological changes in sepsis, the main lesion is vascular
endothelial damage, blood vessel wall inflammation, necrosis and
thrombosis at the same time there is bleeding around the blood
vessels; the skin, subcutaneous tissue, mucous membrane and serous
membrane such as focal hemorrhage.
Those who died in an outbreak of sepsis, autopsy, vascular endothelial
cells in the skin and the cavity can be seen a large number of
Gram-negative meningitis, skin and internal organs severe and
widespread vascular damage, endothelial cell loss necrosis,
intravascular fibrin - white blood cells - platelets to form
thrombosis. Skin, lung, heart, gastrointestinal tract and adrenal
glands have extensive bleeding. Myocarditis and pulmonary edema are
also common.
Meningitis to leptomeningeal lesions of the main. Early congestion, a
small amount of serous effusion and focal small bleeding points. There
are a lot of late fibrin, neutrophils, and plasma extravasation. The
two hemispheres of the brain lesions, mainly in the surface and base
of skull. As thick and purulent pus skull base lesions in direct
invasion, adhesions can cause meningitis, caused by increased optic
nerve, abducens nerve and oculomotor nerve, facial nerve, auditory
nerve and other cranial nerve damage. Endotoxin injury due to
degeneration of brain tissue surface occurs. In addition, inflammation
can also invade the brain tissue along the vessel wall, causing
congestion, edema, neutrophil infiltration and focal hemorrhage.
In fulminant meningitis, the disease mainly to brain tissue, a marked
congestion and edema, increased intracranial pressure. When the edema
of the brain tissue to intracranial prominent hole, the formation of
the foramen magnum, or canopy hiatal hernia.
Small number of children as ventricular meningitis, brain aqueduct
obstruction, caused by obstruction of cerebrospinal fluid circulation
occurs hydrocephalus.
In addition to spinal brain, other organs can also have migration
purulent lesions, including endocarditis, pericarditis, septic
arthritis, pneumonia, eye go far.
[Edit this paragraph] [clinical]
1 to 7 days incubation period, generally 2 to 3 days.
The disease complex, uneven, and can be expressed as three clinical
types of the ordinary type, fulminant, and chronic sepsis model.
(A) of the common type accounting for about 90%. Course of the disease
can be divided into the upper respiratory tract infection, sepsis and
meningitis of the period, but because of acute onset, rapid
development, clinical often difficult to draw.
1. Most of the patients of upper respiratory tract infection does not
produce any symptoms. Some patients have sore throat, nasopharyngeal
mucosal congestion and increased secretion. Nose and throat culture
often can be found in bacteria, it is difficult to diagnose.
2. Sepsis, often without premonitory symptoms of the patient,
processes chills, high fever, headache, vomiting, generalized
weakness. Muscle pain, loss of appetite and apathy of consciousness
and other symptoms of toxemia. Noisy children there crying,
irritability, skin hypersensitivity and convulsions and so on. Small
number of patients with joint pain or arthritis, splenomegaly common.
70% of the patients skin and mucous membranes visible petechia or
ecchymoses. Severe cases petechia, petechiae can be expanded rapidly,
and large areas of necrosis due to thrombosis occurred. Usually about
10% of patients in early disease a few days in the week and other
parts of the lip herpes simplex appears.
3. Meningitis, the majority of patients with sepsis of 24 hours
meningeal irritation occurs around this period of sustained high
fever, severe headache, frequent vomiting, skin hypersensitivity,
sensitive to light, manic and convulsions, coma. Increased blood
pressure and pulse can be slowed down. Stimulation of meningeal
inflammation, manifested as neck pain, neck stiffness, opisthotonus, g
Brandt's sign and positive sign.
Baby attack are atypical, in addition to high fever, refused to milk,
irritability and crying disturbed, the convulsions, diarrhea and cough
more common than in adults, meningeal irritation may be absent.
Anterior fontanel this will help diagnosis. But sometimes because of
frequent vomiting, dehydration only op Hang subsidence, the diagnosis
difficult.
(B) the rapid onset of fulminant small number of patients, the
condition dangerous if not rescue, often within 24 hours within 6
hours or even life-threatening, this type of case fatality rate was
50%, infants and young children up to 80%.
1. Fulminant sepsis (shock type) of the type more common in children.
Processes high fever, headache, vomiting, mental extremely sluggish.
Often occur in the short term systemic broad petechia, ecchymosis, and
rapid integration into a large, subcutaneous bleeding, or followed by
large areas of necrosis. Cang gray complexion, lips cyanotic week and
fingers, limbs Jueleng, skin patterns, fine pulse rate, blood
pressure, or even unpredictable out. Absence of meningeal irritation.
CSF mostly clear, normal or slightly increased cell number, blood
cultures often positive.
2. Resembles fulminant meningoencephalitis seen in children. In
addition to a severe poisoning symptoms, frequent seizures in patients
with rapidly into a coma. Pyramidal tract signs and a positive
reflection on both sides of range. Blood pressure continued to
increase, some patients had cerebral hernia. Hernia foramen magnum,
the cerebellar tonsils herniated into the big hole occipital,
oppression medulla oblongata, at which time patients coma deepened
significantly reduced or dilated pupils, or suddenly big suddenly
smaller, the edge of the pupil is not neat, light unresponsive.
Bilateral increased muscle tone or rigidity, upper limb and more
internal rotation, extension of lower limbs were stiff. Irregular
breathing, or the speed of uneven depth, or suspended, like a sob, or
nod-like breathing, or tidal breathing, these respiratory often
suggest the possibility of a sudden stop breathing. Sky hiatal hernia
between the brain and nerve compression, in addition to the
above-mentioned symptoms of increased intracranial pressure, but often
due to nerve compression and lateral expansion of the pupil, the light
loss of response, eye fixed or outreach, contralateral hemiparesis ,
and then respiratory failure.
3. Hybrid is one of the most serious type of disease, mortality often
up to 80%, plus two clinical manifestations of fulminant, often occur
simultaneously or successively.
(C) the type of rare chronic sepsis. Mostly occurs in adults,
prolonged course of weeks or months. Recurring chills, fever, skin
petechiae, ecchymosis. Joint pain are also common, joint pain, fever
was increased migratory. Meningitis may also occur, heart
inflammation, or nephritis.
[Edit this paragraph] [Diagnostics]
(A) epidemiological data of the disease prevalence in the winter
season, more common in children, adults are not uncommon when a
pandemic.
(B) the processes of clinical manifestations of high fever, headache,
vomiting, skin, mucous membrane petechiae, ecchymosis (in the course
of the disease increased and rapidly expanding), meningeal irritation.
(C) laboratory
1. Significant increase in the total number of blood leukocytes,
generally 10 ~ 30 ¡Á 109 / L or more. Neutrophils in 80 to 90% or more.
Who have DIC, thrombocytopenia.
2. CSF cerebrospinal fluid pressure in the course of the early works
can only be increased, the appearance is still clear, and later in the
muddy rice soup seems like. Cells often up to 1 ¡Á 109 / L, the
neutrophil-based. Protein was significantly higher sugar content
usually less than 400mg / L, and sometimes even zero. Fulminant sepsis
in spinal fluid is often clear, cell count, protein, sugar no change.
Patients with high intracranial pressure, lumbar puncture should be
careful in order to avoid brain herniation. When necessary, the first
dehydration, core needle puncture is not appropriate to allocate all,
but should slowly release a small amount of cerebrospinal fluid for
examination. After completing the waist should be supine patients
after 6 to 8 hours, do not rise up, in order to avoid brain
herniation.
3. Bacteriology
(1) smear examination, including skin petechiae and cerebrospinal
fluid sediment smears. Petechia skin examination, with a barbed tip Po
Yu point on the skin, squeeze a small amount of blood and tissue fluid
applied to the microscope slide staining, the positive rate of up to
80%. CSF smear positive rate of precipitation 60 to 70%.
(2) bacterial culture: ¢Ù blood culture-positive meningococcal
meningitis was low, but chronic diagnosis of meningococcal septicemia
is very important. ¢Ú cerebrospinal fluid culture: the cerebrospinal
fluid placed in sterile centrifuge tubes, take precipitate immediately
inoculated on chocolate agar, while injection of glucose broth, in 5 ~
10% CO2 concentration training.
4. Serological examination was carried out in recent years, rapid
diagnostic method for ECM.
(1) determination of the capsular polysaccharide antigen immunological
tests are counter immuno electrophoresis, latex agglutination test, S.
aureus protein A co agglutination test, the reverse passive
hemagglutination test, enzyme-linked immunosorbent assay for the
detection of other blood cerebrospinal fluid or urine in the capsular
polysaccharide antigens. General in the course of 1 to 3 days, there
may be positive. Positive rate than the bacterial culture method is
simple, rapid, sensitive and specific.
(2) determination of antibody immunological tests are indirect
hemagglutination, bactericidal antibody and so on. Such as
convalescent serum titer of greater than 4 times more acute, there are
diagnostic value.
[Differential Diagnosis]
(A) of the other pneumococcal meningitis, purulent meningitis,
influenza meningitis, staphylococcal meningitis, infection focus most
of the body are present. Such as pneumococcal meningitis, mostly in
pneumonia, otitis media, based on; Staphylococcus aureus sepsis,
meningitis, mostly in the course of the disease. The exact diagnosis
is by cerebrospinal fluid, blood bacteriology and immunology.
(B) of the virtual meningitis in some patients with severe sepsis with
acute infection can occur when the meningeal irritation, but slightly
higher than CSF pressure, the remainder were normal.
(C) tuberculous meningitis more than a history of tuberculosis. Slow
onset, accompanied by fever, night sweats, weight loss and other
symptoms, no blood spots, and herpes. CSF cell count is around tens to
hundreds to lymphocyte predominance. Cerebrospinal fluid in vitro for
12 to 24 when film formation, films and smears of cerebrospinal fluid
acid-fast staining can be detected in precipitation Mycobacterium
tuberculosis.
(D) JE incidence in the 7 to 9 more months, a history of mosquito
bites, serious material injury onset brain, convulsions, coma were
more common, the skin usually no blood spots. Early CSF clear,
slightly muddy late, many cells in the 0.1 ~ 0.5 ¡Á 109 / L, rarely
more than 1 ¡Á 109 / L, protein slightly increased, normal or slightly
higher sugar, oxides normal. Diagnosis depends on double serum
complement fixation test, hemagglutination inhibition test and brain
and other isolated viruses.
[Complications and sequelae]
(A) of the complications include secondary infection, sepsis of spread
to other organs caused by lesions, and purulent meningitis itself
caused the brain and surrounding tissue damage.
1. Secondary infection with pneumonia more common, especially common
in older infants and young children. Other pressure ulcers, corneal
ulcers and urinary retention caused by urinary tract infections.
2. Migratory lesions of purulent otitis media, septic arthritis,
empyema, endocarditis, myocarditis, all ophthalmia, orchitis and
accessories go far.
3. Inflammation of the brain and surrounding tissue or adhesions due
to the damage caused by a nerve palsy, optic neuritis, auditory nerve
and facial nerve damage, limb movement disorder, aphasia, brain
dysfunction, epilepsy, brain abscess. Chronic diseases, especially
infants and young children, or the subarachnoid space due to adhesions
and the ventricle hole between the bridge between meningeal venous
thrombosis phlebitis, can occur with hydrocephalus, respectively, and
subdural effusion.
(B) the after-effects caused by any complications, including common
for the deaf (deaf children development), blindness, nerve palsy,
paralysis, mental, or personality changes, mental disorders.
[Edit this paragraph] [treatment]
(A) the treatment of common type of ECM
1. General treatment of bed rest, keep quiet ward, the air
circulation. Given liquid diet, and coma are advised to nasal feeding,
and I know the amount of input of the liquid above the daily urine
output in 1000ml. Close observation of the disease. Keep the mouth,
the skin clean to prevent corneal ulceration. Constantly changing
position to avoid bedsores occur. To prevent inhalation of vomit.
Necessary oxygen.
2. Symptomatic treatment is available when alcohol sponge bath fever,
severe headache, pain, or may be hypertonic glucose, dehydrated with a
dehydrating agent. Convulsions with 10% chloral hydrate enema, adult
20m / times, children 60 ~ 80mg/kg / times. Or Dongmian Ling,
stability and other sedatives.
3. Pathogen treatment ¢Ù sulfa concentrations in the cerebrospinal
fluid in the blood concentration of up to 50 ~ 80%, often the drug of
choice. Sulfadiazine (SD) of total adult daily 6 ~ 8g, the first full
dose of 1 / 3 to 1 / 2, 6 to 8 hours after administration of each one,
while giving the same amount of sodium bicarbonate. For severe
vomiting, coma 20% of available appropriate diluted sodium
sulfadiazine or intravenous infusion, oral administration to get
better. Oral dose intravenous volume 2 / 3. Children's capacity 0.1 ~
0.15g/kg / day in divided to give. Second, consider the use
sulfamerazine, sulfamethazine sulfamethoxazole or course of 5 days,
severe be extended. Withdrawal as an indicator of clinical symptoms,
do not have to repeat the lumbar puncture. With sulfa drugs should be
given enough fluid to ensure a daily urine volume in 1200 ~ 1500ml or
more, pay attention to hematuria, neutropenia, drug rash, and other
toxic reactions. Such as sulfa-sensitive strains, patients in the post
1 ~ 2 to normal body temperature, consciousness became clear,
meningeal irritation in 2 to 3 days to reduce gradually disappear.
After the use of sulfa drugs, such as the general situation and
meningeal irritation in 1 to 2, who did not improve or worsen, should
consider whether caused by strains resistant to sulfa drugs, disable,
sulfa drugs, to switch to other antibiotics, if necessary, repeat
lumbar puncture again CSF routine culture for drug sensitivity tests.
¢Ú penicillin G penicillin in the cerebrospinal fluid concentration of
the blood concentration of 10 to 30%, high dose injection of the
cerebrospinal fluid of effective bactericidal concentration.
Penicillin-resistant strains have so far been found. Dose of
penicillin G for 15 to 20 million children U / kg / day, daily from
1000 to 12 million adult U, graded intravenous infusion or
intramuscular injection daily for 5 to 7 days. Not suitable for
intrathecal injection of penicillin G, as can cause fever, muscle
twitching, convulsions, meningeal irritation, difficulty breathing,
circulatory failure and other serious reactions. ¢Û chloramphenicol
meningococcus is very sensitive to chloramphenicol, and its
concentration in the cerebrospinal fluid in the blood concentration of
30 to 50% of adult dose of 50mg/kg / day, children 50 ~ 75mg/kg / day
in divided oral, intramuscular injection or intravenous infusion.
Course of 3 to 5 days. Use of chloramphenicol should be close
attention to its side effects, particularly bone marrow suppression,
newborns, the elderly caution. ¢Ü ampicillin ampicillin on Neisseria
meningitidis, influenza and pneumococcal bacteria have a strong
antibacterial effect, it is not clear for pathogens in children under
5 years old. Dose of 200mg/kg / day, divided 4 oral, intramuscular or
bolus.
Large areas of skin ecchymosis ECM
(B) the treatment of fulminant sepsis
1. Large doses of sodium penicillin antibiotic therapy intravenously
at a dose of 20 to 40 million U / kg / day, with the former usage. To
quickly control the sepsis. Chloramphenicol can be applied, but should
not be applied sulfonamides.
2. Anti-shock treatment (see septic shock)
(1) expansion of blood volume
(2) correction of acidosis shock and acidosis often associated with
the merger fever is more serious. Acidosis may further aggravate
endothelial cell damage, decreased myocardial contractility and the
hair cells in blood vessels dilate, and the shock is not easy to
correct. Adult patients can be the first to add 5% sodium bicarbonate
200 ~ 250ml, children 5ml/kg / times, then blood gas analysis results
and then appropriate to add.
(3) the application of vasoactive drugs acid by the expansion and
correction, if the shock has not corrected, can be applied to
vasoactive drugs. If the patient looking dark green ash, peripheral
cyanosis, skin showing patterns, retinal artery spasm, should be used
vasodilator drugs: ¢Ù anisodamine (654-2) 10 ~ 20mg / second bolus.
Children 0.5 ~ 1mg/kg / times, once every 15 to 30 minutes, until the
rise in blood pressure, ruddy, warm limbs, retinal artery spasm may be
extended to ease after half an hour to 1 hour once. If blood pressure
is stable, the condition can be improved to 1 to 4 hours. ¢Ú children
scopolamine 0.01 ~ 0.02mg/kg / second bolus of 10 to 30 minutes once a
reduction Ibid. ¢Û atropine 0.03 ~ 0.05mg/kg / time (no more than 2mg)
in saline intravenously, once every 10 to 30 minutes, reduction above,
the above drugs have anti-sympathetic amines, direct relaxation of
blood vessels, nerve cell membrane stability to relieve bronchial
spasm and reduce the role of bronchial secretions, rarely cause
symptoms of central nervous system excitement. Side effects of
flushing, restlessness, heart rate, urinary retention. At the same
time be supplemented hibernation therapy. If these drugs ineffective,
can switch to isoproterenol or dopamine, or both in combination.
Isoproterenol for the ¦Â-receptor stimulants, can use peripheral
vasodilation, increased cardiac contractility, increased cardiac
output, improve microcirculation, and expansion of renal blood
vessels. Adding 100ml of glucose usually 0.2mg intravenously. After
using the above medications, arterial spasm has improved but remains
low blood pressure or unstable, consider the application of 20 ~ 30mg
intravenous alamin or in combination with dopamine.
(4), cardiac ventricular dysfunction drugs is one of the causes of
shock, plus a large number of rapid intravenous infusion, more heavy
load on the heart may be given rapidly digitalis type cardiac
glycosides, such as hair flowers cardiac C (Cedilanid) Hanako or drug
glycosides K, spin wool.
(5) adrenal cortical steroid hormones may enhance myocardial
contractility and reduce peripheral vascular resistance, stability,
intracellular lysosomal membrane to large doses as well.
Hydrocortisone pine into my daily 300 ~ 500mg, children 5 ~ 8mg/kg,
graded intravenous infusion. Reduction immediately after shock
withdrawal corrected. Medication shall not exceed 3 days. Early is
better.
3. Anticoagulant therapy in view of the disease shock and bleeding and
thrombosis, where a suspected DIC, without waiting for laboratory
results, available hormone treatment. Adult first dose of 1 ~ 2mg/kg,
the addition of 10% glucose injection. According to the circumstances
of each repeated 4 to 6 hours, most 1 or 2 times to be effective in
weight from 3 to 4 times. Heparin should be clotting time test tube
method for the determination of the clotting time of about twice the
normal control (15 to 30 minutes). With heparin to lose new blood to
replenish the clotting factors are consumed. If you have symptoms such
as secondary fibrinolysis, to try 6 - aminocaproic acid, a dose of 4 ~
6g 100ml with 10% glucose infusion, or anti-fibrinolytic aromatic acid
0.1 ~ 0.2g adding grape fluid infusion or bolus .
(C) the treatment of fulminant meningitis in the application of
antibiotic treatment with fulminant shock. In addition, should reduce
brain edema, to prevent herniation and respiratory failure as the
focus.
1. Dehydrating agent and the application of the following drugs should
be alternating or repeated application: ¢Ù 20% mannitol 1 ~ 2g/kg /
times. ¢Ú 25% sorbitol, 1 ~ 2g/kg / times. ¢Û 50% Grapes 40 ~ 60ml /
times. ¢Ü 30% urea, 0.5 ~ 1.0g/kg / times. According to the specific
circumstances of these drugs every 4 to 6 hours rapid intravenous
infusion or bolus once to blood pressure returned to normal, both
sides of the same pupil size, breathing steady. After appropriate
rehydration with dehydrating agent, so that patients remain mild
dehydration. Adrenal cortex hormones may also apply to reduce sepsis
and reduce intracranial pressure.
2. Asia hibernation therapy is mainly used for high fever, frequent
seizures and cerebral edema were obvious in order to reduce brain
water content and oxygen consumption, protect the central nervous
system. Chlorpromazine and promethazine the 1 ~ 2mg/kg, intramuscular
injection or bolus, quiet, post-ice in the pillow, the neck, armpit or
groin, so that the temperature dropped to around 36 ¡æ. Every 4 to 6
hours after intramuscular injection once again, a total of 3 to 4
times.
3. Treatment of respiratory failure should be oriented to prevent
cerebral edema. Who have respiratory failure, in addition to outside
should be given Lobeline dehydration can Lamine, Hui Su Ling and other
central nervous system stimulants. Can also be used scopolamine, 0.02
~ 0.04mg/kg / times intravenously every 20 to 30 minutes once, can
improve the cerebral circulation, respiration and sedation with
excitement. Necessary for endotracheal intubation, suction out the
mucus and secretions, supplemented by artificial respiration until the
patient recovered automatic breathing.
(D) the treatment of chronic sepsis apply the same general type of
antibiotics.
[Edit this paragraph] Progress in the treatment of meningitis
pathogens
Epidemic cerebrospinal meningitis (ECM) have been found more than 100
years, is still popular in many countries, but also our winter and
spring of the more common acute respiratory infections. ECM is the key
to treatment of early and adequate doses of bacteria sensitive to
antibiotics through the blood-brain barrier in order to completely
kill the body meningococcal. At home and abroad in recent years, the
drug used to treat meningitis pathogens conducted more research,
re-established drug of choice; in drug dosage, drug concentrations
were studied also confirmed that the new antibiotic for the treatment
of meningitis in cerebrospinal fluid 20-200 times the concentration to
be measured in vitro minimum inhibitory concentration, 1 dose of the
drug concentration in CSF to be more than 10 times the minimum
inhibitory concentration, the cure rate was 90%, and drugs used in the
proposed the site of infection must have bactericidal effects, such as
use of antimicrobial dose will lead to treatment failure. Currently
used drugs in the treatment of meningitis pathogens are:
1, penicillin
Is well known that penicillin can impede the composition of bacterial
cell wall synthesis - cell wall sticky peptide, the cell walls of
bacteria protect the loss, can not reproduce and survive; at high
concentrations, penicillin will not only inhibit bacterial growth, but
also has a strong bactericidal effect. So far, penicillin is highly
sensitive for meningococcal bactericidal drugs, especially in the
stage of sepsis can rapidly achieve high concentrations, and soon
sterilization, was superior to sulfa drugs. Penicillin is not easy,
but through the blood-brain barrier, even if only 10% of meningitis
-30% of drug through, so you must increase the dose to use in order to
ensure the effective concentration achieved in cerebrospinal fluid.
Daily dose of 20 million -40 million children U / Kg, 20 million
adults every day U / kg, min intravenous drip treatment 5-7 days.
Penicillin efficient, low toxicity, low cost, has been replaced sulfa
drug drug of choice for treating meningitis.
2, sulfa drugs
Advent of sulfa drugs in 1932 for the ECM after it is the first
specific drug for the treatment of ECM. Major obstacles to sulfa drugs
synthesized DNA of bacteria, affect the nuclear protein synthesis, so
that bacteria can not reproduce, play inhibitory role. Treatment of
multi-use ECM sulfadiazine (SD) or sulfamethoxazole (SMZ), its
advantage is that high concentrations in the cerebrospinal fluid,
blood concentration of up to 50% -80%, effects are better. But the
effect of sulfa drugs for sepsis of the poor, high intracranial
pressure, vomiting and acute oral administration is difficult and may
precipitate the formation of stones in the ureter, etc., so the actual
application subject to certain restrictions. In particular it should
be noted that the age of 60 resistant strains have been reported
there, and now at least 10% -20% or even higher, suggesting that
clinical use should be careful. It was argued that only 10% of
resistant strains sulfadiazine below before clinical use.
3, chloramphenicol
Chloramphenicol can inhibit bacterial protein synthesis, is
antibacterial drugs. Chloramphenicol has good antibacterial activity,
and easy through the blood-brain barrier, cerebrospinal fluid
concentration of the blood concentration of 30% -50%, and meningitis
and other purulent meningitis have better effect. However, toxic side
effects of chloramphenicol, in particular, can inhibit bone marrow
hematopoietic function and even cause aplastic anemia, it is to be
very careful selection, is generally not preferred, newborns should
not be used.
4, cephalosporins
Cephalosporins, mainly third-generation cephalosporins, such as
cefotaxime, etc., in recent years to become the rookie treatment
meningitis pathogens. Cephalosporin antimicrobial activity, and easily
through the blood-brain barrier, side effects of small, efficient,
safe, has good application prospects. Since 1989, foreign recommend to
cefotaxime as the drug of choice for treatment of meningitis. However,
not only for domestic use of penicillin or other drugs for patients,
because efficacy of cefotaxime and penicillin rather, the price is
much higher.
[Edit this paragraph] [prognosis]
The disease mortality over the past 70%, the use of sulfa drugs,
penicillin and other antibiotic treatment since the fatality rate
dropped to 5 to 10%. The following prognostic factors: ¢Ù Patients with
fulminant disease risks of a poor prognosis. ¢Ú the age of 2 years of
age and the elderly poor prognosis. ¢Û epidemic peak, the prognosis is
poor. ¢Ü recurrent seizures, persistent coma with poor prognosis. ¢Ý
treatment of late or inadequate treatment have poor prognosis. And
easy to complications and sequelae.
[Edit this paragraph] [Prevention]
(A) place for early detection of patient isolation and treatment of
respiratory tract, good disease reporting. Patients must be isolated
until 3 days after symptoms disappear, but not less than 7 days after
onset. Strengthen disease outbreak surveillance units and regions,
contact medical observation 7; of the flu, nasopharyngitis, skin and
mucosa petechia of patients with suspected disease should be given
enough like the sulfadiazine treatment course of 5 days.
(B) of the vaccine widely used in China to prevent capsular
polysaccharide vaccine group A vaccination to protect more than 90%,
few side effects. Popular before the subcutaneous injection of 1 dose
of 25 ~ 50m¦Ìg, 5 to 7 days after inoculation appeared antibodies
reached a peak after two weeks. A group of foreign preparation, C
group, or A ~ C molecular weight polysaccharide vaccine group
double-high prices, a bactericidal antibody obtained after
subcutaneous injection of 50¦Ìg to make morbidity by 90%. However,
group B vaccine has not yet been developed.
(C) domestic drug prevention still taking sulfa drugs as a precaution.
Prevalence of the disease for some organizations have groups or close
contact with patients, adult daily 2g, children 75 ~ 100mg/kg / day, 2
times, and the same amount of sodium bicarbonate the same clothes for
3 days. Some have argued in the areas of oral sulfa drug resistance to
rifampicin, adult 0.6g / day, children 10mg/kg / day, and even served
for 2 days. Preventive effect of rifampicin good, but easy to produce
drug resistance. Have advocated combination of rifampin and
minocycline, can the carrier rate to zero. Followed by 2 to 3%
available berberine, 0.3% nitrofurazone solution, 1:3000 Dumi Fen,
0.25% chloramphenicol solution nasal spray or hose. 2 times a day,
with 3 days. A group of advocates who have close contact with ECM can
be used triazine cefotaxime injection of a muscle. The method is
simple, effective than rifampin.
(D) to do health promotion work during epidemic improve personal and
environmental hygiene to reduce the large collections and large group
activities, bedroom windows open for ventilation, individuals should
be ground drying of clothes, more than the sun to avoid crowded public
places.
References:
Prevention of meningitis
ECM is the abbreviation of epidemic cerebrospinal meningitis, which is
caused by the meningococcus suppurative inflammation, with a strong
contagious. Winter and spring for the peak of the epidemic, children
under the age of 15 susceptible to the disease, about two years old is
relatively high infant morbidity.
ECM source of infection for the sick and the carriers for the
inhalation route of transmission of pathogens. Bacteria present in the
human nasopharynx secretions, when a person coughs, sneezes or speaks,
the bacteria can spread into the air as droplets, and then inhaled by
others the respiratory tract. If inhaled, the bacteria are physically
strong, good immunity, then the bacteria to breed only in the
nasopharynx, causing respiratory infections. Otherwise, bacteria may
enter the blood circulation, reproduction in the formation of blood
sepsis, and further violations of brain tissue with blood flow outside
the capsule and spinal cord, causing meningitis. The disease
incubation period is usually 2-3 days, the longest for 1 week.
ECM occurs when the initial stage of development in the condition of
the upper respiratory tract infection, some children will be similar
to cold symptoms, such as sore throat, nasal congestion, runny nose,
cough and slight fever. When the bacteria enter the blood and
reproduce, it will be a second period of performance is sepsis.
Children showed persistent high fever, looking pale, apathetic, in the
buttocks, shoulders and other parts of pressure bleeding rash, red or
dark purple, sizes, small for the tip, large patchy. Severe bleeding
can quickly spread to the whole body rash, the occurrence of necrosis.
The third phase of meningitis, children appear severe headache,
vomiting, convulsions and stiff neck and other anomalies.
Because meningococcal meningitis caused by, a particular sensitivity
to strong antibiotics, so the majority of children who, after a
positive drugs sulfa and penicillin resistance to infection and
symptomatic treatment, patients can cured in 1 week. Few serious
subdural effusion in children can be secondary, hydrocephalus
embolism. Young age, degree of deep coma, a long time, the skin
bleeding were extensive and repeated convulsions, are often
life-threatening, or left cerebral palsy and other sequelae.
For many infants and young children, suffering from meningitis, the
disease rapidly changing stage symptoms may not be typical or obvious,
there will be serious life-threatening. So, do the prevention of
meningitis is particularly important.
Maintain the indoor air fresh and clean, always open doors and windows
ventilation or spray air freshener, often drying bedding, to kill
pathogens in the environment. Because meningococcus is relatively
weak, its dry, hot and humid, very sensitive to cold and general
disinfectant, in less than 37 ¡ã C or above 50 ¡ã C environment are
likely to die.
Epidemic cerebrospinal meningitis epidemic in the season, try not to
let the children go to crowded public places, to avoid increasing the
chances of infection. In addition, once that child has unexplained
fever, bleeding or headache, vomiting, convulsions, etc., should be
immediately sent to hospital for treatment.
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