OVERVIEW
OVERVIEW
Gram-negative enterobacterial meningitis is a diffuse inflammatory change of the soft meninges caused by bacterial infection of Enterobacteriaceae. There may be high fever, headache, lack of appetite, vomiting, mental depression and other manifestations, with the progression of the disease may appear delirium, convulsions, coma and even shock.
Whether medical insurance
Yes, it is
Department
Pediatrics, Neurology
Clinical symptoms
Weakness of suckling, high fever, headache, lack of appetite, vomiting, depression, delirium, convulsions and coma.
Hazards
Ventricular meningitis is very easy to complicate, and in severe cases, brain herniation, coma or even shock may occur, which is life-threatening.
Complications
Ventricular meningitis, etc.
Examination
Routine examination of cerebrospinal fluid, cerebrospinal fluid smear and bacterial culture, latex agglutination test, convective immunoelectrophoresis, direct immunofluorescence antibody test, X-ray, CT, MRI and so on.
Diagnosis
Diagnosis is made on the basis of high fever, headache, signs of focal or diffuse neurological impairment, combined with cerebrospinal fluid smear and bacterial culture, latex agglutination test, and imaging tests.
Treatment principle
Control infection, symptomatic and supportive treatment, prevention and treatment of complications.
Curability
The disease is very likely to be complicated by cerebral ventricular meningitis, which is one of the causes of poor prognosis and leads to serious sequelae.
Dietary advice
Enhance nutrition, eat a high-calorie, high-protein, fiber-rich and vitamin-rich diet.
Causes
Etiology
Mainly caused by bacterial infection of Enterobacteriaceae.
Symptoms and Diagnosis
Typical symptoms
The main manifestations are weak sucking, reduced sucking and even refusal of food, depression, vomiting, irritability, screaming, lethargy, respiratory distress and cyanosis. The body temperature is unstable, and in premature babies, the body temperature often does not rise, while full-term babies may have fever. The onset of the disease in childhood is more acute, with symptoms such as high fever, headache, lack of appetite, vomiting, mental depression, etc. Continued progression of the disease may result in delirium, convulsions, coma or even shock. Those with diffuse meningitis may have high fever, persistent headache and neck stiffness, headache is limited to the affected side in the early stage, and then the headache worsens and spreads to the whole head, and convulsions and coma may occur in severe cases. Significantly increased intracranial pressure may lead to cerebral hernia, pupil, respiratory and heart rate changes and even respiratory and circulatory failure.
Other symptoms
Otogenic meningitis is often accompanied by thrombosed venous sinusitis or brain abscess. If there is sepsis, jaundice, bruises, abdominal distension, liver and spleen enlargement, shock and so on may appear.
Diagnostic basis
1. Weakness of suckling, high fever, headache, depression, delirium, convulsion, coma and so on.
2. Cerebrospinal fluid smear and bacterial culture show pathogenic bacteria.
3. Cerebrospinal fluid has turbid appearance and increased number of leukocytes.
4. Latex agglutination test, convection immunoelectrophoresis, direct immunofluorescence antibody test and other tests to detect cerebrospinal fluid bacterial antigens are important for the diagnosis of the disease.
5. X-ray examination often shows destruction of mastoid bone. If brain abscess is suspected, CT or MRI examination can be used to confirm the diagnosis.
Treatment
Treatment guideline
Reasonable choice of effective antibiotics to control infection at an early stage, symptomatic and supportive treatment, prevention and treatment of complications.
Drug treatment
Early and rational selection of effective antibiotic treatment is extremely important, most of the third-generation cephalosporins have a strong bactericidal effect on gram-negative bacilli, such as cefotaxime, ceftriaxone, ceftazidime and so on. Piperacillin can also be used in combination with gentamicin or amikacin.
Other treatments
To prevent intracranial adhesions due to fibrinous exudates, cerebrospinal fluid replacement may be performed.
Prognosis
The disease is highly susceptible to complications of cerebral ventricular meningitis, which is a cause of poor prognosis and leads to severe sequelae.
Nursing care
Daily care
Ensure sufficient sleep, avoid overuse of brain and exertion.
Pay attention to climate change, avoid cold, and avoid going to crowded public places.
Encourage the children to express their inner feelings, explain the knowledge about the disease to them and build up their confidence to overcome the disease.
Enhance physical fitness and prevent upper respiratory tract infections.
Dietary management
Enhance nutrition, eat high-calorie, high-protein, fiber-rich and vitamin-rich diet.
Other Attention
Educate children to develop good hygiene habits.