Overview
Gram-positive coccus meningitis includes staphylococcal meningitis, pneumococcal meningitis and streptococcal meningitis. Staphylococcus aureus meningitis is mostly secondary to Staphylococcus aureus septicemia, mostly seen in patients with endocarditis of the left heart; pneumococcal meningitis is disseminated, mostly seen in winter and spring, and mostly seen in infants and young children, and elderly patients or patients with chronic diseases; meningitis caused by streptococcus infection is rare in all purulent meningitis, and streptococcal meningitis is mostly caused by A streptococcus. Treatment can be based on anti-inflammatory and symptomatic treatment with sensitive antibiotics.
Causes
1. Staphylococcal meningitis
(1) Meningitis caused by Staphylococcus aureus is mostly secondary to Staphylococcus aureus septicemia, which is especially common in patients with combined left endocarditis, and invades the meninges through bacterial emboli via the bloodstream.
(2) Infectious foci near the meninges, such as otitis media, mastoiditis, sinusitis, etc., can also cause the disease.
(3) Craniocerebral injury, craniocerebral surgery and lumbar puncture can also complicate the disease.
(4) Facial carbuncle boil complicating cavernous sinus thrombophlebitis can further lead to the disease.
2. Pneumococcal meningitis
Pneumococcal meningitis is often secondary to pneumonia or pneumococcal sepsis, followed by otitis media, mastoiditis and sinusitis and other infections, some patients secondary to craniocerebral trauma and fracture or after brain surgery, a few cases have no clear primary lesion.
3. Streptococcal meningitis
This disease occurs more often in otitis media, mastoiditis and paranasal sinusitis and other local foci of spread; also seen in lung infection, urinary tract infection, sepsis and subacute bacterial endocarditis and other blood-borne infections.
Symptoms
1. Staphylococcal meningitis
The disease starts rapidly, often with systemic symptoms of infection and toxicity, such as chills and fever, accompanied by persistent and severe headache and neck stiffness. Patients with sepsis may also develop a rash, such as urticaria-like, scarlet fever-like rash or small pustules, with bleeding dots on the skin, which seldom merge into patches.
2. Pneumococcal meningitis
Pneumococcal meningitis occurs secondary to various pneumococcal pneumonias, most occurring within 1 week of onset of illness, with a few occurring more than 10 days later. The interval between otitis media, sieve sinusitis and meningitis is about 1 week; the interval between meningitis and craniocerebral injury is more than 1 month.
The disease starts sharply with high fever, headache, vomiting, and impaired consciousness, which is manifested as delirium, lethargy, coma and so on. Cerebral nerve damage accounts for about 50% of the cases, mainly involving the motor and facial nerves, while the buccal and abducens nerves may also be involved. Skin petechiae are rare.
3. Streptococcal meningitis
The clinical manifestations of this disease are not specific, and sometimes petechiae can be seen on the skin.
Examination
1. Blood routine examination
White blood cell count and neutrophil ratio are obviously increased.
2. Smear examination
Gram-positive cocci can be found in the smear, which are often arranged in chains, and a positive bacterial culture can confirm the diagnosis.
Diagnosis
Diagnosis can be made on the basis of history, clinical manifestations and the presence of Gram-positive cocci in the smear.
Treatment
1.Drug treatment
(1) Staphylococcal meningitis S. aureus is resistant to most antibiotics, so every effort should be made to culture the bacteria and conduct drug sensitivity test to guide the rational use of drugs. Before the results of culture come out, it is advisable to use enzyme-resistant penicillin such as benzathine or cloxacillin intravenously or intravenously. For the treatment of streptococcal meningitis, in addition to the selection of appropriate antibiotics, early treatment of localized lesions is very important. Desmethyl vancomycin has strong antibacterial activity against Aureobasidium, and desmethyl vancomycin should be used for penicillin-allergic patients or those caused by methicillin-resistant strains.
(2) Pneumococcal meningitis Penicillin is the drug of choice, the dose should be large, intravenous. After the symptoms improve and the cerebrospinal fluid is near normal, adults continue to use the drug until the temperature and cerebrospinal fluid are normal, and the course of treatment should not be less than 2 weeks. Intrathecal administration of penicillin may lead to adverse reactions such as convulsions, fever, subarachnoid adhesions, myelitis and radiculitis, so it is not suitable.
(3) Streptococcal meningitis The drug treatment of this disease is based on penicillin, and sulfonamides are only used in conjunction.
2. Treatment of primary disease
Actively treat the primary disease, such as otitis media, mastoiditis and paranasal sinusitis and other localized lesions.
Prognosis
The disease has a high mortality and disability rate. The prognosis is closely related to the pathogenic bacteria, the condition of the organism and the early and effective application of antibiotic therapy. A small number of patients may be left with mental retardation, epilepsy, hydrocephalus and other sequelae.
Prevention
Avoiding triggering factors is the most important, for example, don’t squeeze the carbuncle boil in the facial triangle, so as not to complicate cavernous sinus thrombophlebitis, which will further lead to meningitis; actively treating the primary pathology, for example, localized foci such as otitis media, mastoiditis and paranasal sinusitis.
Nursing care
This disease is advisable to rest, while strengthening nutrition, diet should be light, nutritious, avoid spicy stimulating food.