Viral vs Bacterial Meningitis
Meningitis is inflammation of the meninges caused by bacteria, viruses,fungi或者寄生虫。细菌和病毒脑膜炎均相同。临床病史，检查发现，调查方法和治疗方案的方法是相同的。但是，研究结果，特定治疗和预后不同。重要的是要正确诊断，因为病毒性脑膜炎是自限性的，并且没有长期后遗症，而细菌性脑膜炎则更为严重，如果怀疑脑膜炎，应毫不拖延地治疗。本文将详细讨论脑膜炎，强调其临床特征，症状，原因，调查和诊断，预后，治疗以及细菌和病毒脑膜炎之间的差异。
Meningitis is a killer, and it kills quickly. Organisms like E coli, beta hemolytic streptococci, Listeria moncytogenes, Heamophilus, Nisseria meningitidis, pneumococcuscause脑膜炎。脑膜炎出现头痛，当暴露于光线，僵硬的脖子，kernig的标志（臀部被完全弯曲的被动膝盖伸展上的疼痛和阻力），布鲁兹斯基标志（臀部向前弯曲）和Opisthotonus时，会恶化。这些被称为meningeal features。脑膜炎增加了头骨内部的压力。这是特征的特征是头痛，烦躁，嗜睡，呕吐，适合，乳头毛，意识水平降低，不规则呼吸，低脉搏率和high blood pressure(Read the脉搏率和血压之间的差异). When the organism enters the bloodstream septic signs like feeling ill, joint swelling, joint pain, odd behavior, rash, diffuse intravascular coagulation, rapid breathing, rapid pulse, and low blood pressure occur.
治疗for meningitis should not be delayed until test results arrive. If meningitis is suspected, nothing should delay intravenous antibiotics. Airway, breathing, and circulation should be maintained. High flow oxygen therapy via a face mask is good. Treatment protocol differs according to the presentation. If septic signs predominate, lumbar puncture should not be attempted. If the patient is in shock, volume resuscitation is indicated. If meningitic features predominate at presentation, lumbar puncture should be attempted if no features of increased intracranial pressure are present. Intravenous antibiotics should be given. If there is any indication of respiratory failure, intubation should not be delayed.
并发症of meningitis are cerebral edema, cranial nerve lesions, deafness, and cerebral venous sinus thrombosis. Lumbar puncture is critical to diagnosis. If there are no features of increased intra cranial pressure, the lumbar puncture should be done. If there are features of increased pressure inside the skull, CT should precede lumbar puncture. 3 bottles of cerebrospinal fluid should be sent for gram stain, Zheil neilson stain,cytology，病毒学，葡萄糖，蛋白质和培养。脑脊液分析可能在早期阶段正常。如果指示的腰穿应重复。可以指出其他测试，例如血液培养，血糖，全血细胞计数，尿素，电解质，胸部X射线，尿液培养，鼻拭子和粪便进行病毒学。
Risk factors脑膜炎是过度拥挤,头部受伤,发生ctive focus, very young, very old, complement deficiency, antibody deficiency, cancers, sickle cell disease, and CSF shunts. Acute bacterial meningitis has mortality of 70 to 100% untreated; Neisseria meningitides has an overall mortality of 15% in the west. Survivors are at risk of permanent neurological deficits, mental retardation, sensorineural deafness and cranial nerve palsies.
What is the difference between Bacterial and Viral Meningitis?
• Bacterial meningitis has a poor prognosis while viral meningitis is self –limiting, has a good prognosis and no long term sequelae.
• Upon lumbar puncture, CSF looks turbid in bacterial meningitis while it looks clear in viral meningitis.
•单核细胞在病毒性脑膜炎中占主导地位，而多晶型细胞占细菌性脑膜炎。
• White cell count in CSF is less than 1000 in viral meningitis while it’s more than 1000 in bacterial meningitis.
• CSF glucose concentration is less than half of that of plasma in bacterial meningitis while, in viral meningitis, CSF sugar concentration is more than half of that of plasma.
• CSF protein concentration is more than 1.5g/L in bacterial meningitis while it is less than 1g/L in viral meningitis.
• There are organisms visible in smear or culture, in bacterial meningitis while no organisms are seen in viral meningitis.
Read also the脑膜炎和脑膜炎球菌之间的差异
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