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Abstract: A 7-year-old child with a recent cold and fever suddenly developed a high fever at night, accompanied by limb convulsions, and was brought to the hospital by his family. After a comprehensive examination, a diagnosis of acute meningitis was made and admission to the hospital was recommended. After 14 days of standard drug treatment, the child’s condition was stable without any special discomfort, and all the test results were normal.
Basic information】Male, 7 years old
Disease Type】Acute meningitis
Hospital】Shandong Provincial Third Hospital
Time of consultation】May 2019
Treatment plan】Intravenous medication (dexamethasone sodium phosphate injection, diazepam injection, ceftriaxone sodium for injection) + physical cooling + nutritional support therapy
Treatment Period】Hospitalization 14 days, outpatient review after 1 month
Treatment effect】The child’s condition is stable, no special discomfort, the results of various tests are normal
I. Initial consultation
The child was brought to the hospital at night by his family, and was in a state of hyperthermia, with continuous twitching of the limbs, accompanied by nausea and vomiting. Mental ambiguity, positive meningeal stimulation signs, and uncooperative physical examination. The initial consideration was upper respiratory tract infection, epilepsy, and meningitis could not be excluded. We communicated in detail with the family that the child was in serious condition and needed to be hospitalized immediately, and the family understood and actively cooperated.
II. Treatment history
After admission, the child was given dexamethasone sodium phosphate injection to reduce heat treatment and physical cooling, and diazepam injection to sedate the child with persistent epilepsy, and the body temperature dropped after about 30 minutes, and the convulsions improved. The diagnosis of acute meningitis was confirmed. Subsequently, a lumbar puncture examination of cerebrospinal fluid showed an increased white blood cell count and a significant decrease in sugar and chloride, and the child was given anti-infective treatment with ceftriaxone sodium for injection, as well as nutritional support. After 7 days of hospitalization, the child’s condition improved, and he became clearer, without fever, and the inflammation index gradually decreased to normal. After 14 days of hospitalization, the child was discharged with stable condition, no special discomfort, normal blood test results and normal cerebrospinal fluid pressure. It is recommended to follow up with an outpatient clinic in 1 week to review the cranial MRI.
III. Treatment effect
The child’s condition was serious. Immediately after admission, the relevant examination was improved, and medication was given at the same time. Dexamethasone sodium phosphate injection was given to reduce heat treatment, and the body temperature dropped to normal after 3 days of hospitalization. Diazepam injection was given to sedate the persistent epilepsy, and ceftriaxone sodium for injection was given to treat the infection. After 14 days of hospitalization, the child was discharged with stable condition, no special discomfort, normal blood test results, and normal cerebrospinal fluid pressure on recheck.
IV. Notes
We are glad that the child was discharged from the hospital after active treatment. After discharge, we should pay attention to the child’s temperature and diet, and if there is repeated hypothermia, we should visit the hospital and recheck the blood routine, C-reactive protein and cranial MRI. Usually, you should develop good habits, rest on time, supplement nutrition and strengthen immunity. Family members should avoid contact with the affected child if they have a cold. The child should visit the hospital for a follow-up examination when he/she is discharged from the hospital for 1 month.
V. Personal insight
Because of their young age, children with low immunity and poor resistance may develop acute meningitis secondary to a cold if not actively controlled. Once a persistent fever with headache and confusion occurs, the child should be seen in the hospital immediately to avoid delays. For clinicians, they should pay attention to the regression of abnormal signals of inflammation in the child’s brain during the emergency period and advise parents to bring the child to the hospital regularly for follow-up to avoid repeated aggravation of the disease.