化膿性腦膜炎英文

化膿性腦膜炎英文第1頁，課件共42頁，創(chuàng)作于2023年2月Acuteinfectionofcentralnervoussystem(CNS).90%ofcasesoccurintheageof1mo-5yr.Theinflammationofmeningescausedbyvariousbacteria.Commonfeaturesinclinicalpracticesinclude:fever,increasedintracranialpressure,meningealirritation.Oneofthemostpotentiallyseriousinfections,associatedwithhighmortality(about10%)andmorbidity.PurulentMeningitis第2頁，課件共42頁，創(chuàng)作于2023年2月Etiology1.1Pathogens:Mainpathogens:Neissriameningitidis,streptoccuspneumoniae,Haemophilusinfluenzae.(2/3ofpurulentmeningitisarecausedbythesepathogens)Pathogensinspecialpopulations(neonate&<3moinfants,malnutrition,immunodeficiency):gramnegativeentericbacilli,groupBstreptococci,staphlococcusaureus

第3頁，課件共42頁，創(chuàng)作于2023年2月1.2Majorriskfactorsformeningitis

ImmatureimmunologicfunctionandattenuatedimmunologicresponsetopathogensLowlevelofimmunoglobulin,defectsofcomplementandproperdinsystemImmatureorimpairedblood-brain-barrier(BBB)

ImmatureBBBfunction:maturationatabout1yrImpairedBBB:Congenialoracquireddefectsacrossmucocutaneousbarrier

第4頁，課件共42頁，創(chuàng)作于2023年2月

1.3AccessofbacteriainvasionTypicalaccess---hematogenousdissemination

BacteriacolonizingthemucousmembranesofthenasopharynxinvasionintolocaltissuebacteremiahematogenousseedingtothesubarachnoidspaceModeoftransmission:Persontopersoncontactthroughrespiratorytractsecretionsordroplets第5頁，課件共42頁，創(chuàng)作于2023年2月Bacteriaspreadtothemeningesdirectly:throughanatomicdefectsintheskullorheadtraumaInvasionfromparameningealorgans:suchasparanasalsinusesormiddleearAccessofbacteriainvasion第6頁，課件共42頁，創(chuàng)作于2023年2月2.PathologyStructureofmeninges第7頁，課件共42頁，創(chuàng)作于2023年2月Characterizedbyleptomeningealandperivascularinfiltrationwithpolymorphonuclearleukocytesandaninflammatoryexudate.Exudatewhichmaybedistributedfromconvexityofbraintobasalregionofcranium.Exudateismorethicknessduetostreptococcuspneumoniaethanotherpathogens.Pathology第8頁，課件共42頁，創(chuàng)作于2023年2月3.ClinicalmanifestationsTheyoungerthechildis,thehigherincidenceofmeningitiswillbe.?-2/3ofcasesoccurlessthan1yrofage.Modeofpresentation:Acuteorfulminantonset:symptomsandsignsofsepsis;meningitisevolverapidlyoverafewhoursanddeathwithin24hours;usuallyinfectedwithNeissriameningitides(N.meningitides).

第9頁，課件共42頁，創(chuàng)作于2023年2月

Subacuteonset:Precedebyseveraldaysofupperrespiratorytractorgastrointestinalsymptoms;difficulttopinpointtheexactonsetofmeningitis;usuallywithmeningitisduetoHaemophilusinfluenzae(Hinfluenzae)andstreptoccuspneumococcus(Spneumococcus).Modeofpresentation第10頁，課件共42頁，創(chuàng)作于2023年2月Commonfeaturesofmeningitis:

signsofsystemicinfection:fever(90-95%),anorexia,shock,alterationofmentalstatusandconsciousnessneurologicalsigns:increasedintracranialpressure:headache,vomiting(82%),herniationmeningealirritation:nuchalrigidity(77%),kernigsign,brudzinskisign

Clinicalmanifestations第11頁，課件共42頁，創(chuàng)作于2023年2月brudzinskisign第12頁，課件共42頁，創(chuàng)作于2023年2月

Seizure(20-30%)

FocalorgeneralizedDuetocerebritis,infarction,electrolytedisturbancesFrequentlynotedwithHinfluenzae&SpneumococcalmeningitisPersistafter4thdayanddifficulttotreatwithpoorprognosisClinicalmanifestations第13頁，課件共42頁，創(chuàng)作于2023年2月

Clinicalmanifestations

AlterationofmentalstatusandconsciousnessIncluding:irritability,lethargy,stuporobtundation,comaDuetoincreasedintracranialpressure,cerebritis,hypotensionOftenwithpneumococcalormeningococcalmeningitisComatosepatientswithapoorprognosis第14頁，課件共42頁，創(chuàng)作于2023年2月Thesymptomsandsignsarenotevidentinneonatesandinfantsyoungerthan3moofage;andpatientsalreadyreceivedirregularantibiotictherapy.Clinicalmanifestations第15頁，課件共42頁，創(chuàng)作于2023年2月SignsofsystemicinfectionIncreasedintracranialpressuremeningealirritationTypical(olderchildren)Fever,alteredconsciousness,seizureHeadache,vomiting,herniationnuchalrigidity,backpain,kernigsign,brudzinskisignAtypical(neonate&<3moinfant)Fever,normaltemperatureorhypothermia;minimorsubtleseizure;poorfeeding;lessactivityScream,frown;bulgingorfullfontanel;wideningofthesuturesNotevidentComparisonofthemanifestationsofmeningitisbetweendifferentagegroupsClinicalmanifestations第16頁，課件共42頁，創(chuàng)作于2023年2月4.DiagnosisEarlierdiagnosisandpromptinitiationofeffectiveantibiotictreatmentiscriticalforminimizingsequelaeofpurulentmeningitis.Suspectedcases:febrileinfantswithseizure,meningealirritability,increasedintracranialpressure,alteredmentalstatusPayattentiontotheatypicalsymptomsandsignsinneonate,infantandpatientalreadyreceivedirregularantibiotictherapy

第17頁，課件共42頁，創(chuàng)作于2023年2月Diagnosisisconfirmedbyanalysisofcerebrospinalfluid(CSF)Suggestionbacterialmeningitis

Increasedpressure(90%)Appearance:slightlycloudytopurulentRaisedwhitebloodcells,consistingchieflyofpolymorphonuclearleukocytesRaisedproteinconcentration,decreasedglucoseconcentration(80%)

Diagnosis第18頁，課件共42頁，創(chuàng)作于2023年2月

Confirmationofthediagnosis:isolationfromtheCSFofaspecificbacterialpathogenbymicroscopyorapositivecultureorrapidantigen-detectiontestofCSFGram-stainedsmearofCSF:identifythecausativeorganismin70-90%ofcasesCSFculture:positiveinabout80%ofcases.definitivediagnosis,determinationofantibioticsensitivity.PCR:amplifiesbacterialDNA(Hinfluenzae,N.meningitidis)Diagnosis第19頁，課件共42頁，創(chuàng)作于2023年2月5.Differentialdiagnosis

PurulentmeningitiscausedbydifferentpathogensNeissriameningitidis:Occurinepidemics(typeA,C),whichismorecommoninspring,orsporadicalltheyear(typeB,C,Y)Suddenonsetwithvariouscutaneoussigns(petechiae,purpura,oranerythematousmacularrash)

第20頁，課件共42頁，創(chuàng)作于2023年2月Streptococcuspneumoniae:Younginfants(<1yr)aremostsusceptiblepopulationPeakseason:springandwinterEasiertohavesubduraleffusionand

hydrocephalusEasilyhaveaprotractedcourseandrelapseDifferentialdiagnosis第21頁，課件共42頁，創(chuàng)作于2023年2月

HaemophilusinfluenzaeOccurspredominantlyininfants2moto2yrofageManycasesareinwinterHigherincidenceofsubduraleffusion

Otherspathogens:staphylococcusaureus,gramnegativeentericbacilliSpecialsusceptiblepopulation:neonate,<3moinfants,malnutrition,immunodeficiencySevereinfection,difficulttotreatDifferentialdiagnosis第22頁，課件共42頁，創(chuàng)作于2023年2月

Meningitiscausedbyothermicroorganisms

Viralmeningitis/encephalitis:

Lessseveresystemicinfectioussymptoms

Usuallynotdevelopafter2-3weeks

CSF:normalglucose

Differentialdiagnosis第23頁，課件共42頁，創(chuàng)作于2023年2月Tuberculousmeningitis

Subacuteonsetandprogress

AhistoryofclosecontactwithknowncasesoftuberculosisEvidenceofacuteorhealedtubercularinfectiononchestx-rayTuberculinskintest:OT,PPDCSFDifferentialdiagnosis第24頁，課件共42頁，創(chuàng)作于2023年2月DiseasePressure(Kpa)aspectTotalWBC(x106/L)Protein(g/L)Glucose(mmol/L)smearsculturesnormal0.69-1.96(0.29-0.78)clear0-5(0-20)0.2-0.4(0.2-1.2)2.2-4.4--Purulentmeningitiscloudy(PMN)(1-5)(<2.2)Gram’sstain++TuberculousmeningitisNormalorcloudy(MN)AFBstain+Viralmeningitis/encephalitisNormalorNormalNormalor(MN)Normalor(<1)normal-FungalmeningitisNormalorNormalorcloudy(MN)Indiainkprep+Cerebrospinalfluidinneurologicinfection第25頁，課件共42頁，創(chuàng)作于2023年2月6.Complicationsandsequelae6.1SubduraleffusionDefinitivediagnosis:volumeoffluidinsubduralspace>2ml,protein>0.4g/L,Incidence:developin10-30%ofpatients,asymptomaticin85-90%ofpatients;especiallycommonininfants4-6monthofage(rareinchildrenover1yr);第26頁，課件共42頁，創(chuàng)作于2023年2月Causativeorganisms:45%ofcasesofmeningitiscausedbyHinfluenzae,30%bySpneumoniae,9%byNmeningitidissubduraleffusion第27頁，課件共42頁，創(chuàng)作于2023年2月

Indications:NoresponsetoasensitiveantibiotictherapyProlongedfeverorfeverreoccurringafteranafebrileintervalwitheffectivetreatmentBulgingfontanel,wideningofsutures,enlargingheadcircumference,emesis,seizure,alteredconsciousness.ImprovedCSFprofilewithmoreseriousclinicalmanifestationssubduraleffusion第28頁，課件共42頁，創(chuàng)作于2023年2月Diagnosismethods:

CranialtranslucenttestBultrasonicexaminationandCTSubduralspacepuncturesubduraleffusionnormalsubduraleffusion第29頁，課件共42頁，創(chuàng)作于2023年2月6.2Ventriculitis6.3hydrocephalusComplications第30頁，課件共42頁，創(chuàng)作于2023年2月Circulationofcerebrospinalfluid(CSF)第31頁，課件共42頁，創(chuàng)作于2023年2月6.2VentriculitisUsuallyoccursinneonatesandinfants(<1yr),withsevereprognosisThemaincauseisdelayeddiagnosisandtreatmentofmeningitis.

Complications第32頁，課件共42頁，創(chuàng)作于2023年2月Diagnosis:Bultrasonicexaminationorneuroimagingstudies(CT,MRI):enlargedlateralventricleLateralventriclepuncture:bacteriaandinflammatorycellsinventricularfluid,WBC>50x106/L,Glucose<1.6mmol/L,orprotein>400mg/L.Ventriculitis第33頁，課件共42頁，創(chuàng)作于2023年2月Circulationofcerebrospinalfluid(CSF)第34頁，課件共42頁，創(chuàng)作于2023年2月6.3hydrocephalus:Communicatinghydrocephalus:adheredordestroyedarachnoidgranulationaroundthecisternatthebaseofthebrainObstructivehydrocephalus:followingobstructedofthecerebralaqueduct,ortheforaminaofMagendieandLuschka6.4others:Deafness,blindness,paralysis,epilepsy,mentalretardationComplications第35頁，課件共42頁，創(chuàng)作于2023年2月Treatment7.1AntibacterialtherapyTherapyprinciples:earlytreatment,antibioticssusceptibletopathogensandwithhighpermeabilitythroughBBB,givenintraveninously,enoughdose,enoughcourseofantibiotictherapy

第36頁，課件共42頁，創(chuàng)作于2023年2月SusceptibletopathogensFirstchoice:Cefotaxime,Ceftriaxone(3drgenerationofcephalosporins,highpermeabilitythroughBBB,productsofmetabolismalsohaseffect,CSFsterilizationwithin24h)Otherchoice:Penicillin,Chloromycin,Cefuroxime,Ceftazidime(delayedeffecttomakeCSFsterile,highincidenceofrelapseanddeafness)Antibacterialtherapy第37頁，課件共42頁，創(chuàng)作于2023年2月EtiologyStandardantibioticsofchoiceDurationoftherapyH.influenzaeCefotaxime/Ceftriaxone7-10daysN.meningitidisCefotaxime/Ceftriaxone7daysS.pneumoniae