Overview of Streptococcal Meningitis
Streptococcal meningitis is commonly caused by Streptococcus pneumoniae, while other streptococci are less common, accounting for only about 5% of cases. In recent years, the incidence of meningitis caused by other streptococci, such as group B streptococci, has been reported to be on the rise, and the morbidity and mortality rates are high, which deserves clinical attention. Streptococcal meningitis is disseminated, with no obvious seasonality. It occurs most often in patients with severe underlying disease, but also in previously healthy individuals.
Etiology
Streptococcal meningitis is mostly secondary to subacute bacterial endocarditis, mastoiditis, sinus or pharynx and other suppurative foci, but also due to systemic infections, and it is not uncommon for craniocerebral trauma fracture-causing pathogens to invade the meninges directly.
Symptoms
The clinical manifestations of streptococcal meningitis are more or less the same, there may be nausea, vomiting, fever, headache, impaired consciousness, etc., and may be combined with otitis media, pharyngitis and the corresponding manifestations of localized infections.Patients with group B streptococcal meningitis may cause cerebral infarction and hemiplegia if cerebral blood vessels are involved in the early stage of the disease, some of the patients may suffer from coma, epilepsy, shock, acute respiratory failure, acute renal failure and other complications.Group A streptococcal meningitis Seizures, hearing and vision impairment, unresponsiveness and other sequelae occur in some patients.
Examination
1. Cerebrospinal fluid examination
Cerebrospinal fluid is obtained by lumbar puncture for routine examination and bacterial culture.
2.Antigen test
In the absence of bacteria, polymerase chain reaction (PCR) is used to detect Streptococcus pneumoniae-specific DNA, which can confirm the diagnosis.
3. Blood tests
Peripheral blood has a significantly higher leukocyte and neutrophil count.
Diagnosis
Diagnosis can be made on the basis of clinical manifestations such as nausea, vomiting, fever, headache, and impaired consciousness, combined with the results of blood and cerebrospinal fluid examination.
Treatment
1. Antibiotic treatment
Advocate the use of high-dose penicillin, in order to choose penicillin sodium salt is appropriate. Intrathecal injection is generally not advocated. If the child is allergic to penicillin or the bacteria are resistant to penicillin, drugs such as chloramphenicol or third-generation cephalosporins should be selected according to the drug sensitivity test. Antibiotics are used until the cerebrospinal fluid is completely normalized about 2 weeks after discontinuation, the full course of treatment requires more than 3 weeks. When the treatment goes well, repeated lumbar puncture to check the cerebrospinal fluid is not necessary.
2. Treatment of primary disease
Otitis media, mastoiditis, craniocerebral trauma and other primary diseases should be treated at the same time, and the cause of recurrent meningitis should be found out and completely cured. The child should rest in bed and be supplied with sufficient water.
Prognosis
Prompt treatment can reduce the occurrence of sequelae.
Prevention
Actively treat the primary disease.
Nursing care
Do a good job of hygiene management to avoid re-infection with pathogenic bacteria, eat a light diet, balanced nutrition, and improve the body’s immunity.