GB 16884-1997 Diagnostic criteria and management principles for epidemic cerebrospinal meningitis
Some standard content:
GB16884-1997
Epidemic cerebrospinal meningitis (abbreviated as meningitis) is a purulent meningitis caused by Neisseria meningitidis (Nm) through respiratory transmission. It often causes disease and epidemics in winter and spring. Children are the most common patients, and the incidence of adults also increases during epidemics. Most people infected with Nm show a nasopharyngeal carrier state, and only a few become meningeal patients. The main clinical manifestations are sudden high fever, headache, vomiting, skin and mucous membrane bleeding spots or ecchymoses, and neck stiffness, etc. Meningeal irritation signs, and cerebrospinal fluid shows purulent changes. In addition, Nm may not invade the cerebrospinal meninges, but only show sepsis, and severe cases may present an fulminant attack. In order to implement the "Law of the People's Republic of China on the Prevention and Control of Infectious Diseases", conscientiously carry out the work of epidemiological monitoring and control of meningococcal meningitis, prevent the disease from rebounding significantly, and control its epidemic, this standard is specially formulated. Appendices A and B of this standard are standard appendices; Appendices C, D, E and F are all suggestive appendices. This standard is proposed by the Ministry of Health of the People's Republic of China. The responsible drafting unit of this standard is the Institute of Epidemiology and Microbiology, Chinese Academy of Preventive Medicine, and the participating drafting units are Beijing You'an Hospital and Beijing Municipal Health and Epidemic Prevention Station.
The main drafters of this standard are Hu Xujing, Xu Lianzhi and Wu Guikun. The technical unit entrusted to the Office of Supervision and Administration of Communicable Disease Prevention and Control of the Ministry of Health is responsible for the interpretation of this standard. 253
1 Scope
National Standard of the People's Republic of China
Epidemic Cerebrospinal Meningitis
Diagnostic criteria and principles of manegementfor epidemic cerebrospinal meningitis This standard specifies the diagnostic criteria and principles of management for epidemic cerebrospinal meningitis. GB16884-1997
This standard is applicable to the diagnosis, reporting and management of cases of epidemic cerebrospinal meningitis by medical care, health and epidemic prevention institutions and personnel at all levels and of all types. 2 Diagnostic principles
2.1 Clinical diagnosis should be made based on epidemiological data, clinical manifestations and laboratory test results. 2.2 Confirmation requires the culture of Nm or the detection of Nm group-specific polysaccharide antigens or Nm DNA-specific fragments or the detection of anti-Nm specific antibodies in the patient's acute and convalescent serum.
3 Diagnostic criteria
3.1 Epidemiological history
In winter and spring and in epidemic areas, children are most likely to be sick. Some patients have a history of close contact 7 days before the onset of the disease. 3.2 Clinical manifestations
3.2.1 Sudden chills, high fever, nausea, vomiting, stagnation, nasal congestion, sore throat, body pain, and worsening headache. 3.2.2 Pale complexion, cold limbs, mottled skin with scattered small hemorrhages, cyanosis around the lips and fingertips, and simple herpes around the lips. Irritability, delirium, coma or convulsions. 3.2.3
Skin and mucous membrane petechiae are typical or merged into ecchymosis, blood pressure drops significantly, pulse is thin and rapid, and pulse pressure difference decreases. 3.2.5 Neck stiffness, opisthotonos, positive Klinefelter's sign and Brudin's sign. 3.2.6 Pupils of different sizes, irregular edges, slow reaction to light, and frequent staring of the eyes. 3.2.7 Uneven breathing speed and depth or apnea. 3.2.8 In young children, the disease is often atypical. In addition to high fever, vomiting, and drowsiness, extreme restlessness and convulsions, breast refusal, screaming, diarrhea, coughing, staring eyes, neck stiffness, and positive Brudin's sign are also common. Other signs of meningeal irritation may be absent. Those with patent fontanelles often have bulges, and those with frequent vomiting and dehydration may also have sunken fontanelles.
3.3 Laboratory diagnosis
3.3.1 Blood picture: The white blood cell count is significantly increased, up to 40×10\/L, and the neutrophil count is above 80% to 90%. 3.3.2 Patients suspected of having meningococcal meningitis should undergo lumbar puncture. The pressure of cerebrospinal fluid (CSF) often increases to more than 1.96 kPa. In typical cases, the appearance of CSF is turbid, like rice soup or even pus. The number of white blood cells increases, reaching hundreds of millions per liter, mainly polymorphonuclear cells. The protein content increases significantly, reaching 1-5 g/L. The sugar content is often lower than 2.22 mmol/L, and the oxides are also slightly reduced. Gram-negative diplococci can be found in neutrophils in CSF smears.
3.3.3 Nm is separated from the patient's CSF or acute blood, see Appendix A (Appendix to the standard). Approved by the State Administration of Technical Supervision on June 16, 1997 251
Implementation on January 1, 1998
GB16884-199 7
3.3.4 Nm group-specific polysaccharide antigens were detected from the patient's acute phase serum, urine or CSF, see Appendix C (standard appendix). 3.3.5 The serum antibody titer of the patient's recovery phase was detected to be 4 times or more higher than that of the acute phase, see Appendix B (standard appendix). 3.3.6 Nm DNA-specific fragments were detected in the patient's acute phase serum or CSF by PCR, see Appendix D (suggestive appendix). 3.4 Case classification
3.4.1 Suspected case: 3.1 plus one of 3.2.1 or 3.2.2 or 3.2.3. 3.4.2 Clinically confirmed case: Suspected case plus one of 3.2.4 or 3.2.5 or 3.2.6 or 3.2.7. 3.4.3 Confirmed case: Suspected case Or for clinically confirmed cases, add item 3.3.3 or 3.3.4 or 3.3.5 or 3.3.6. 4 Treatment principles
4.1 For early treatment of patients, see Appendix E (suggestive Appendix). 4.1.1 Report the epidemic to the health and epidemic prevention department in a timely manner. 4.1.2 Isolate on the spot, provide emergency treatment, and reduce the mortality rate. 4.1.3 Give antimicrobial drugs to control the infection in time. 4.1.4 Early detection and timely correction of shock and disseminated intravascular coagulation (DIC). 4.1.5 If symptoms of increased intracranial pressure are detected early, dehydration therapy should be used in time to prevent and treat brain hernia and respiratory failure. 4.2 For the treatment of susceptible populations, see Appendix F (suggestive Appendix). 4.2.1 People in close contact with patients who have upper respiratory tract infection-like patients should be treated as mild cases. Treatment of patients with meningococcal disease. 4.2.2 Based on the results of epidemiological monitoring, formulate a plan for the preventive injection of group A meningococcal polysaccharide vaccine, complete the vaccination task in the early stage of the epidemic, and the vaccination rate of immunized subjects should reach more than 90%. 4.2.3 In addition to completing the routine immunization tasks of the above-mentioned vaccines, group A meningococcal polysaccharide vaccines should also be prepared for emergency vaccination to control outbreaks of meningococcal disease.
4.2.4 When an outbreak of meningococcal disease caused by group A Nm occurs in unimmunized areas, in addition to children under 15 years old, adults who have close contact with patients should also be given the above-mentioned vaccines as appropriate. 4.2.5 At present in my country, if a local outbreak of meningococcal disease caused by non-group A Nm occurs, antibiotics should be used for prevention in a timely manner for the patient's entire family and their adjacent neighbors.
GB16884-1997
Appendix A
(Standard Appendix)
Methods for the diagnosis of meningococcal pathogens
A1 Isolation of pathogens (Neisseria meningitidis) Collect CSF or acute blood from patients suspected of meningococcal disease to isolate Nm. A1.1 Collection of specimens
A1.1.1CSF: Aseptically operate, aspirate 2mL of CSF, immediately put it into a sterile test tube for centrifugation (2000~3000r/min, 30min), use a sterilized capillary to aspirate the precipitate and directly inoculate it on 10% sheep blood chocolate agar (the CSF supernatant is used to detect Nm specific antigens, and it can also be placed at -20C for testing), and culture it at 37C in a 5% carbon dioxide environment for 24~72h. Check the bacterial growth every day and isolate the pure culture in time for identification.
A1.1.2 Blood: Take 6mL of venous blood from the patient in the acute phase, and aseptically inject 4mL of blood into a triangular bottle containing 30mL of glucose broth for bacterial enrichment (the remaining 2mL of blood is centrifuged as above and serum is aspirated for the detection of Nm specific antigens and antibodies, or it can be placed at -20℃ for testing), and cultured under the above conditions for 24 to 72 hours, and separate and cultured every day. A1.2 Inoculation and strain identificationwwW.bzxz.Net
A1.2.1 Bacterial morphology: Nm should be Gram-negative, oval or kidney-shaped, 0.8um×0.6μm in size. Often arranged in pairs, with concave flat apples on both sides
A1.2.2 Colony: Nm is inoculated on chocolate agar. 5% carbon dioxide, 37C culture for 24 hours, the colony diameter is about 1mm, the surface is protruding, smooth, moist, round, slightly grayish white, translucent, non-hemolytic, and non-pigmented. As the incubation time increases, the colonies will grow larger, turn yellow, become opaque, and may develop a granular center and a radioactive periphery. A1.2.3 Growth and antigenic characteristics: Most Nm strains decompose glucose and maltose, producing acid but not gas. They do not decompose sucrose, fructose and lactose. They are positive for peroxidase and oxidase. Newly isolated Nm strains have the following main antigens: serogroup-specific capsular polysaccharides, major outer membrane proteins-OMP (including serotype-specific class 2/3 OMPs, subtype-specific class 1 OMPs, and class 4 and 5 OMPs), iron regulatory proteins, liposaccharides (LOS), H.8 lipoproteins, and pili antigens, etc. Based on the structure and composition of group-specific capsular polysaccharides, Nm can be divided into 13 serogroups (A, B, C, D, 29EH, I, K, L, W135, X, Y, Z), of which more than 90% of cases are caused by group A, B and C Nm. According to class 2/3 MP, group B and group C Nm can be divided into 20 serotypes, but almost half of them cannot be typed before the strain is introduced. Among the typable strains, types 15, 2 and 4, subtypes P1.2, P1.1, P1.12, P1.15 and P1.16 are the most common. For the existing serotypes 4 and 21 of group A Nm, subtypes P1.7 and P1.9 are the most common. Nm can also be divided into 13 1.0S immunotypes. Among them, types L10 and L11 are the most common in group A, and L3.7.9 complex type is the most common in group B. The antigenic components of Nm group-specific membrane polysaccharides, types and subtypes of OMP and L.OS are of great value to the study of the incidence and prevalence of meningococcal disease and its vaccine.
Appendix B
(Standard Appendix)
Methods for serological diagnosis of meningococcal disease
B1 Slide agglutination test
B1.1 Purpose
Use slide agglutination test to serologically group Nm pathogenic strains or carrier strains. B1.2 Materials
B1.2.1 Pure culture of Nm strain to be tested. GB16884-1997
B1.2.2 Nm diagnostic serum: Multivalent 1 (including A, B, C, D groups), Multivalent I [including 1889 (Y), 1890 (H), 1892 (29E) J, Multivalent 1 [including 319 (W135), 1916 (X), 1486 (I), 1811
Tip: This standard content only shows part of the intercepted content of the complete standard. If you need the complete standard, please go to the top to download the complete standard document for free.