Roord J J, Kaandorp C J
Academisch Ziekenhuis Vrije Universiteit, afd. Kindergeneeskunde, Amsterdam.
Ned Tijdschr Geneeskd. 2001 Feb 3;145(5):211-4.
Neisseria meningitidis and Streptococcus pneumoniae are the most frequent causes of bacterial meningitis. The incidence of Haemophilus meningitis in the Netherlands is low due to successful Haemophilus influenzae type b vaccination. This implies that there is no need to take account into this microorganism in using initial empiric antimicrobial therapy for bacterial meningitis. Vomiting (especially children), headache, fever, and a stiff neck characterize acute bacterial meningitis. However, even without these signs a patient may still have acute bacterial meningitis. The characteristics in neonates are less specific. An emergency lumbar puncture should be performed in all patients with meningeal irritation or other signs of bacterial meningitis. Examination of the CSF is not indicated for convulsive children (between the ages of 6 months and 6 years) who do not exhibit other clinical signs. In patients who respond adequately to the treatment, it is not necessary to examine the CSF again. Papilloedema or focal neurological symptoms contraindicate a lumbar puncture in patients with bacterial meningitis, until CT results justify that it can be performed safely. Antibiotic treatment should not be delayed until after the CT. General practitioners should treat their patients with suspected meningococcus infection by admitting them to the hospital without first injecting antibiotics. In the Netherlands, patients with suspected pneumococcus meningitis may still be treated with benzylpenicillin. Patients with bacterial meningitis have no fluid restrictions; only in case of the syndrome of inadequate secretion of antidiuretic hormone is fluid reduction indicated. The physician is responsible for prescribing prophylaxis to family members. The Regional Health Services organize chemoprophylaxis for classmates. The latter is only indicated if at least 2 related cases occur in one month.
脑膜炎奈瑟菌和肺炎链球菌是细菌性脑膜炎最常见的病因。由于成功接种了b型流感嗜血杆菌疫苗，荷兰流感嗜血杆菌脑膜炎的发病率较低。这意味着在使用细菌性脑膜炎的初始经验性抗菌治疗时无需考虑这种微生物。呕吐（尤其是儿童）、头痛、发热和颈部僵硬是急性细菌性脑膜炎的特征。然而，即使没有这些症状，患者仍可能患有急性细菌性脑膜炎。新生儿的症状特异性较低。所有有脑膜刺激征或其他细菌性脑膜炎迹象的患者都应进行紧急腰椎穿刺。对于没有其他临床症状的惊厥儿童（6个月至6岁），不建议进行脑脊液检查。对治疗反应良好的患者无需再次检查脑脊液。视乳头水肿或局灶性神经症状是细菌性脑膜炎患者腰椎穿刺的禁忌证，除非CT结果证明可以安全进行。抗生素治疗不应延迟至CT检查之后。全科医生应对疑似脑膜炎球菌感染的患者进行住院治疗，而不首先注射抗生素。在荷兰，疑似肺炎球菌脑膜炎的患者仍可用苄星青霉素治疗。细菌性脑膜炎患者没有液体限制；仅在抗利尿激素分泌不足综合征的情况下才需要减少液体摄入。医生负责为家庭成员开预防药。地区卫生服务机构为同学组织化学预防。只有在一个月内至少发生2例相关病例时才进行后者的预防措施。
