Bacterial Meningitis

2021-03-23 12:00 AM

Due to trauma or surgery to the brain or spine area, or due to infection with a spinal puncture, common pathogens are Staphylococcus aureus, Streptococcus aureus, bacillus blue pus

Bacterial meningitis, also called pyelonephritis, is caused by a variety of bacteria that cause pus.

Classification according to the aetiology of bacteria

Classified by popularity

Common bacteria causing meningitis: Meningococcal, H. influenzas, Pneumococcus ...

Uncommon bacteria causing meningitis: E. coli, Staphylococcus aureus, Streptococcus ...

Rare bacteria causing meningitis: Proteus, Bacillus green pus, Salmonella, Listeria, Klebsiella ...

Classification by age

The researches of the authors around the world divide very different ages. However, we can generalize as follows:

Infants (<2 months old): Bacillus intestine (E. coli ...), Streptococcus group B, Listeria monocytogenes ...

 2 months - 18 years: H. influezae, Meningococcal, Pneumococcus, E. coli, Staphylococcus ...

18 - 50 years old: Meningococcal, Hemisphere ...

Over 50 years old: Pneumococcus, L. monocytogenes ...

Common bacterial etiologies that cause meningitis with age can be modeled as follows:

Categorize the cause according to the location

Common bacterial etiologies cause atopic meningitis (Causing secondary purulent meningitis).

Atopic

Common bacteria

- Alcoholism

- Diabetes

- Inflammation of the middle ear

- Reduce immune resistance

- After splenectomy

- After trauma, traumatic brain injury

- After neurosurgery

Have mitral valve disease

Hemisphere, Listeria

Hemisphere, Listeria, S. aureus

Pneumococcus, intestinal TK, S. aureus

Listeria

Listeria, H. influezae

Pneumococcus, intestinal bacillus, S. aureus, H. influezae

S. aureus, TK gram (-)

S. epidermidis, S. aureus

Classification according to the way bacteria penetrate the meninges

Depending on the penetration of bacteria into the meninges, people can divide into two types of meningitis:

Primary purulent meningitis

Due to meningococcal or H. influenzae directly penetrates the meninges through the bone sieve.

Secondary purulent meningitis

Bacteria from the inflammatory foci near the meninges, the medullary membrane penetrates, such as ear infections, mastitis, skull inflammation, sinusitis, orbital inflammation, muscle inflammation along the spine ... The pathogen is usually H. influezae, Pneumococcus, Staphylococcus aureus, Streptococcus ... penetrates the meninges through access or via the lymphatic pathway.

Bacteria from a distant inflammatory drive (such as antennae, pneumonia, endocarditis, uterine infections, intestinal infections, urinary tract infections ...) cause sepsis and bacteria cross the barrier blood vessels - meninges into the meninges. Pathogens in these cases are usually: Streptococcus, H. influezae, Staphylococcus aureus, Streptococcus, Bacillus pus, E. coli, Salmonella ...

Due to trauma or surgery to the brain, spine ... or by a spinal puncture that causes infection. Common pathogens are: Staphylococcus, Streptococcus, Bacillus blue pus.

General clinical features of bacterial meningitis

Syndrome of infection - intoxication

Usually onset is acute, sometimes intense with manifestations: Constant high fever, cold spikes, headache, muscle and joint fatigue ... When sepsis often has high fever fluctuations, there are many tremors. during the day, liver and spleen enlargement etc .. Some cases may have endotoxin shock, angioplasty, low blood pressure, low urination ...

Blood test: Depending on the type of pathogen, but often an increase in leukocytes, neutrophils (neutrophils) increase ...

Meningeal syndrome

Commonly develops rapidly, frantically, with relatively complete symptoms:

Severe headache, easy vomiting. Children often vomit, stop feeding, drowsiness, fussiness, irregular breathing, cyanosis, or convulsions ...

Nape (+), Kernig (+), Brudzinski (+) ... Children have a "trigger pose", a tendency to be afraid of light and sound, bulging, "meningeal moan" ...

There are manifestations of increased intracranial pressure.

The typical CSF of meningitis is purulent water in many different degrees (opaque, cloudy, thick pus ...); Increased protein (1-2 g / liter); Low glucose, sometimes only traces left; cell proliferation (usually at the level of thousands of cells / mm3), in the majority cell formula or mostly polymorphonuclear leukocytes, there are many degenerative, purulent cells. In atypical cases, cerebrospinal fluid may be clear, bloody or lemon yellow ...

Primary infection can be found

Such as ear infections, mastoiditis, sinusitis, beard nails, pneumonia, urinary tract infections, metritis, vaginitis ...

Complications - Sequelae and mortality of bacterial meningitis

Symptoms

Damage to the cranial nerve: in purulent meningitis can damage the cranial nerves such as wire II, III, IV, VI, VII, VIII ...

Brain abscess, subdural abscess, purulent foci along the bloodstream, thrombophlebitis, cerebrovascular crust ...

Cerebrospinal fluid obstruction and meningeal thickening interfere with cerebrospinal fluid circulation, hydrocephalus syndrome.

There are also complications outside the nervous system, depending on the cause of the bacteria such as toxin shock, visceral bleeding (seen in sepsis, meningitis due to meningitis), arthritis, endocarditis conjunctivitis, pericarditis, nephritis, pneumonia ...

Sequelae

After suffering from meningitis, especially those with a late diagnosis of treatment, the following complications may occur:

Strabismus, deaf, dumb, blind, hydrocephalus ...

Localized nerve damage causing paralysis (paralysis of 1 limb, hemiplegia, paralysis of the lower extremities, brain nerve damage ...)

Memory loss, dementia, mental disorders ...

Epileptic.

Dead

In recent years, many good antibiotics have been put into use. However, the average mortality rate in many countries in meningitis due to meningitis is 7-10%, due to pneumococcus is 30%, caused by H. influezae is 10-14% ... Causes of death are:

Early: Respiratory failure, severe brain edema, irreversible shock ...

Late: Complications of severe infections in the brain and outside the brain (brain abscess, pneumonia, nephritis, extensive ulcers and exhaustion, prolonged brain loss leading to brain failure ...)

Diagnosis of bacterial meningitis

It should be based on the following factors:

Infection-intoxication syndrome is usually acute, severe.

Meningeal syndrome is clear, rapidly growing and with relatively enough symptoms.

Brain marrow fluid is cloudy, Protein increases, Glucose decreases much, cells increase (usually halo thousand cells / mm3), the majority of leukocytes and many degenerative cells, pus. Cerebrospinal fluid culture: Pathogenic bacteria can be found. However, in atypical cases, the cerebrospinal fluid may be clear, blood or lemon yellow ...

When CSF is clear, it may still be mild early meningitis (CSF is not cloudy), but the most common is "head loss" meningitis (which is meningitis but is antibiotic topical treatment and recovery). However, it is necessary to make differential diagnosis with other clear water meningitis or meningitis.

When cerebrospinal fluid has blood, it can be meningitis with meningeal hemorrhage (usually meningococcal ...), but need differential diagnosis with subarachnoid hemorrhage due to other causes or technical errors. when puncturing the lumbar spinal canal.

When the cerebrospinal fluid is lemon yellow: It can be purulent meningitis with hemorrhage, degenerative red blood cells or tuberculosis meningitis ...

General principle of treatment of bacterial meningitis

Specific treatment

It is necessary to combine etiological diagnosis and early antibiotic specific treatment: When there is a patient with suspected meningitis, it is necessary to promptly perform fundoscopy, lumbar spinal puncture to obtain cerebrospinal fluid, direct examination immediately cultured bacteria. Then need to use antibiotics early, do not wait until the new bacteria results to use antibiotics. When the diagnosis is suspected between meningitis with other types of meningitis, the best treatment attitude is treatment towards meningitis. After a few days, the cerebrospinal fluid should be checked again and the disease progressed to evaluate the next treatment direction.

Choose an antibiotic according to the pathogen and according to the antibiotic chart. When the pathogen is unknown, it is necessary to choose an antibiotic with a broad spectrum of effects. Should choose an antibiotic that penetrates well through the meninges. If antibiotics diffuse poorly into the meninges, but are sensitive to pathogens, high doses (for example: Penixillin, Ampixilin ...) must be used. Some types of multidrug-resistant bacteria with many types of antibiotics (such as bacillus green pus, staphylococcus aure ...), need to specify antibiotics that are little or not resistant such as Fluoroquinolone, Ceftazidim, Vancomyxin, Imipenem, Meropenem. ..

Ideally, antibiotics should be administered intravenously. Do not give the drug directly into the spinal canal.

Antibiotic choice depends on the patient's location, local drug resistance, physician's experience ... Therefore, it is impossible to have a general regimen, applicable to all patients. Here are just suggestions:

Choice of antibiotics for meningitis

(Theo Greenwood B.M., 2000)

Type VK

Antibiotic

Way in

Adults

Children

Time (days)

Meningococcal

Penicillin G

TM (BT)

2 million UI x 4 times / day

1 million UI x 4 times / day

7

Pneumococcal

Penixilin G or

Ceftriaxon

TM, (BT)

TM

4 million UIs x 4 times / day

2-4g / day

1 million UI x4 l / day

100mg/kg/ng

10-14




 

H. Influences

Ceftriaxone or

Chloramphenicol

TM

TM, (BT)

-

-

100mg/kg/ng

25mg / kg x 4 times / day

 

7

 

Unclear

Ceftriaxone or

Chloramphenicol

TM

TM, (BT)

5 g / day


500mg x 4 times / day

100mg/kg/ng

25mg / kg x4 times / day

10-14

 

Note: The above is a suggestion, when applying, it should be adjusted appropriately in actual conditions. Particularly chloramphenicol in infants: not more than 50 mg / kg / 24 hours.

Symptomatic treatment

Anti-edema: By rapid intravenous infusion of Mannitol 15-20% or magnesium sulfate ...

Sedation, anticonvulsants with Diazepam, Phenobarbital ...

Anti-shock and cardiomyopathy by infusion, Ouabain ... When there is endotoxin shock (common in meningitis and meningococcal sepsis), corticoids (Prednisolon, Dexamethazole) should be used at high doses, short-term infusion. veins, Isuprel ...

Anti-breathing failure: Put the patient in a draining position, absorb phlegm, breathe oxygen ...

When a fever is high, especially for children who need to prevent febrile seizures, it is advisable to reduce the fever with a cool towel, take off clothes, have ventilation ... When necessary, the fever can be reduced by Paracetamol and combined with tranquillizers.

Good nourishment, prevention and prevention of ulcers etc ..

Managing complications

When meningeal thickening: Use corticoid given into the spinal canal.

Brain abscess: Needs surgery.

Cerebral thrombophlebitis, intravascular clotting syndrome (DIC): Heparin therapy.