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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