Early detection and identification of meningitis

  Early meningitis manifests as some non-specific symptoms. Children often see the doctor with respiratory and digestive symptoms, such as fever, sore throat, nasal congestion, and vomiting, so they are often overlooked. However, as the condition worsens, symptoms such as repeated high fever, headache, vomiting, poor spirits, pale and gray complexion, rapid oliguria, cold and cyanosis of the extremities, increased breathing and heart rate, and/or respiratory failure will occur. , Some patients show severe shock, brain damage, and even life-threatening. If meningitis can be diagnosed and treated in time, most of them recover quickly and the prognosis is good. So, how can we detect and diagnose meningitis early?
  1. Analyze from the epidemiological history. ECM is highly contagious, and it is generally prevalent in winter and spring, especially from February to April. Therefore, if a child develops the disease during this time period, especially from an area with cases of ECM, he has been in contact with or may have been in contact with patients with ECM. Need to consider the possibility of meningitis.
  2. Analyze from physical examination. Most children with meningitis have petechiae and ecchymosis on their skin within a few hours of the disease, and some of them have fused into pieces. Therefore, the skin and mucous membranes of the whole body of the child should be carefully checked; neck stiffness indicates meningitis. If you find the above-mentioned abnormalities, pay close attention to the possibility of meningitis.
  3. From the analysis of laboratory inspections. When the above-mentioned epidemiological history and symptoms, physical examination are suspected of meningitis, blood tests are required. The total number of white blood cells and neutrophils in routine blood examination were significantly increased, and those with fulminant DIC had thrombocytopenia. At the same time, a lumbar puncture and cerebrospinal fluid extraction is required. It can be seen that the pressure of the cerebrospinal fluid is increased, the appearance is cloudy or rice soup, the number of white blood cells can reach millions per liter, mainly neutrophils, the protein content is increased, the sugar is significantly reduced, and the chloride is reduced . It should be noted that the change of cerebrospinal fluid may not be obvious at the beginning of the disease, and the cerebrospinal fluid should be checked again after 1 to 2 days. For a small number of children with significantly increased intracranial pressure, lumbar puncture may induce brain herniation, leading to the risk of sudden respiratory and cardiac arrest. Doctors must strictly control the pointer operation.
  At the same time that meningitis is initially found and treated in time, it is necessary to continue to improve the etiological examination.
  1. Smear microscopic examination. Take skin petechiae puncture fluid or cerebrospinal fluid precipitation smear for microscopic examination, the positive rate of bacteria can reach more than 50%.
  2. Bacterial culture. Early throat swab culture can detect meningococcal bacteria, and blood culture and cerebrospinal fluid culture can detect the bacteria.
  3. Immunological examination. Take the cerebrospinal fluid or blood or urine of the child for antigen test, or blood antibody test.
  4. Nucleic acid inspection. PCR method was used to detect meningococcal-specific DNA fragments in serum or cerebrospinal fluid.
  Many diseases in clinic are similar to the clinical manifestations of meningitis, so it is necessary to pay attention to distinguish them, as listed below.
  1. Other purulent meningitis. Other purulent meningitis can also have neurological symptoms such as fever, headache, mental changes, but it will not cause infection and epidemics, and most of the skin and mucous membranes have no petechiae, ecchymosis, and rarely complicated with DIC. The exact identification depends on cerebrospinal fluid or Etiological examination of blood.
  2. Tuberculous meningitis. Most have a history of tuberculosis exposure, slow onset, and often have symptoms of tuberculosis poisoning such as low fever, night sweats and weight loss. In addition to meningitis, lung photos or CT examinations are often accompanied by changes in pulmonary tuberculosis, tuberculin skin test, blood, and cerebrospinal fluid The examination indicated a change in tuberculosis.
  3. Viral meningitis. Viral meningitis is caused by a viral infection. Symptoms of systemic blood poisoning are often not obvious. There are no skin petechiae and ecchymosis. Blood and cerebrospinal fluid examinations indicate viral infection. There is no bacterial growth in culture and identification is easier.
  4. Toxic bacillary dysentery. Sudden onset, may have high fever, convulsions, coma, shock or respiratory failure, cerebrospinal fluid examination except for increased pressure, no other abnormalities, generally people with unclean diet or contact with dysentery. It is more common in summer and autumn. A large number of pus and red blood cells can be seen routinely in the feces, and Shigella can be detected in culture.
  5. Thrombocytopenic purpura. There is often a history of acute viral infections 1 to 3 weeks before the onset, manifested as skin bleeding or petechiae. Most children have no other abnormal symptoms, some may have fever, and no meningitis-related symptoms. Routine blood examination revealed a significant decrease in platelet count.
  6. Infective endocarditis. Fever is a common manifestation, skin and mucous membrane ecchymosis may occur, usually basic heart disease, heart color Doppler ultrasound can show valve neoplasms, blood culture is common microorganisms of infective endocarditis (Streptococcus viridans, Staphylococcus aureus, etc.) , No encephalitis performance.
  In general, it is not difficult to distinguish according to the clinical manifestations of each disease, combined with epidemiological history and laboratory and etiological examinations.