[PS6-1B-2] Diagnosis and treatment of bacterial meningitis in children
Childhood bacterial meningitis (BM) is, for the whole world, one of the most common infectious diseases involving central nervous system. Many factors are associated with the morbidity of BM, including pathogens, age, and immune capacity. About 90% patients with BM are under 5-year-old, especially infants less than 1-year-old. The classical symptom of BM is characterized by fever, convulsion, intracranial hypertension, meningeal irritation, and purulent CSF. In addition to the atypical clinical manifestation of infants BM and few positive findings about pathogens, the diagnostic value of CSF measurement is limited due to substandard treatment with antibiotics, thus which presently result in the diagnosis for partial childhood BM become more difficult, and more patients have intractable BM with antibiotic resistance. So far BM is one of the ten infectious diseases with the highest mortality rate, and about 30%-50% survivors cases may suffer from permanent neurological sequelae.
Many guidelines were presented by different countries for improving the early diagnosis of BM, and giving standard antibiotic therapy in time, which contributed to help the doctors to identify the atypical manifestation of infants BM, or perform lumbar puncture at an opportune time. Presently new technology was developed to improve the positive rate of pathogens, and the accessory diagnostic value of inflammatory indicators was evaluated reasonably. Meanwhile, in order to offer a useful way to facilitate clinical diagnosis and treatment, many studies were committed to set up BM diagnostic models. At present, with the widespread use of Haemophilus type B conjugate vaccine, the main pathogens of BM are Neisseria meningitidis and Streptococcus pneumoniae. Simultaneously, the infants BM caused by opportunistic pathogens and Gram-negative bacteria was increased gradually. Considering the changes of pathogens and increases of drug-resistant bacteria, the strategy combined the third-generation cephalosporin with vancomycin became the first choice for empirical antibacterial therapy. While after known the specific pathogens, antibiotics should be chosen according to the results of sensitivity tests. Once the symptom of BM don’t relieve as expected, reevaluation should be performed actively to recognize the possible occurrence of misdiagnosis, bacterial resistance, the underlying diseases of patients, complications and so on, which is most important for definitive therapy and improving the prognosis of children with BM.
Many guidelines were presented by different countries for improving the early diagnosis of BM, and giving standard antibiotic therapy in time, which contributed to help the doctors to identify the atypical manifestation of infants BM, or perform lumbar puncture at an opportune time. Presently new technology was developed to improve the positive rate of pathogens, and the accessory diagnostic value of inflammatory indicators was evaluated reasonably. Meanwhile, in order to offer a useful way to facilitate clinical diagnosis and treatment, many studies were committed to set up BM diagnostic models. At present, with the widespread use of Haemophilus type B conjugate vaccine, the main pathogens of BM are Neisseria meningitidis and Streptococcus pneumoniae. Simultaneously, the infants BM caused by opportunistic pathogens and Gram-negative bacteria was increased gradually. Considering the changes of pathogens and increases of drug-resistant bacteria, the strategy combined the third-generation cephalosporin with vancomycin became the first choice for empirical antibacterial therapy. While after known the specific pathogens, antibiotics should be chosen according to the results of sensitivity tests. Once the symptom of BM don’t relieve as expected, reevaluation should be performed actively to recognize the possible occurrence of misdiagnosis, bacterial resistance, the underlying diseases of patients, complications and so on, which is most important for definitive therapy and improving the prognosis of children with BM.