感染病學(xué)（上海交通大學(xué)）流行性腦脊髓膜炎

MeningococcalMeningitis流行性腦脊髓膜炎meningococcalmeningitisIntroduction亞撒哈拉非洲被稱(chēng)為'MeningitisBelt'.不管是興旺國(guó)家，還是開(kāi)展中國(guó)家，80%的細(xì)菌性腦膜炎由3種致病菌引起:HaemophilusinfluenzaetypeB(Hib),StreptococcuspneumoniaeandNeisseriameningitidismeningococcalmeningitisIntroduction

meningitidis,thecausativeorganismofmeningococcalmeningitis,wasfirstisolatedfromcerebrospinalfluidanddescribedin1887byWeichselbaummeningococcalmeningitisIntroduction

感染涉及：腦膜炎、菌血癥、呼吸道、關(guān)節(jié)、心包、眼、泌尿生殖系等主要臨床表現(xiàn)：FeverHeadacheVomiting

Neckstiffness

AdiffusemaculopapularrashJointpainPhotophobiameningococcalmeningitisBacteriaTheNeisseriafamilyismadeupofmorethan10species.Only2ofthemareofclinicalimportance

N.gonorrhoeae,responsibleforgonorrhea,N.meningitidis,responsibleformeningococcaldisease.meningococcalmeningitisBacteriaG-，‘diplococci’，φ0.6~1.0μmCanbefoundinblood,CSF,purpurameningococcalmeningitisBacteriameningococcalmeningitisBacteria專(zhuān)性需氧菌巧克力色血瓊脂平板5%-10%CO2meningococcalmeningitisBacteria

A,B,C,

D,E29,H,I,K,L,W135,X,YZA占90%以上meningococcalmeningitisDistributionofpredominantN.meningitidisserogroups(A,B,C),1996–1997Source:Can.Commun.Dis.Rep.1999;25(ACS-5)/(DDC-5)][98]meningococcalmeningitisBacteriaEndotoxin致病因素自溶酶及時(shí)培養(yǎng)meningococcalmeningitisEpidemiologySourceTheonlynaturalhostofmeningococcusisman.Becausenasopharyngealcarriageofmeningococciissomuchmorefrequentthanmeningococcaldisease,nasopharyngealcarriers,ratherthanpatientswithmeningitis,aretheusualsourceofnewinfections.meningococcalmeningitisEpidemiologyTransmissionwayTransmissionofN.meningitidisdirectlyfrompersontoperson,occursbythedropletspreadofnasopharyngealsecretions〔經(jīng)呼吸道傳播〕Throughcloseoralcontact(密切接觸傳播)meningococcalmeningitisEpidemiologyRiskGroupsmokers,peoplewholivedinovercrowdedhouseholds,andmilitaryrecruits.5歲以下兒童,尤其是6月齡~2歲.老年人.meningococcalmeningitisEpidemiologyEpidemiccharacteristicSeasonandPeriodicity全年發(fā)病多見(jiàn)于11月~5月，3~4月頂峰流行周期不如過(guò)去明顯meningococcalmeningitisEpidemicsofMeningococcalmeningitis,1971–1997

meningococcalmeningitisPathogenesis細(xì)菌

咽喉部呼吸道上呼吸道感染宿主抵抗力細(xì)菌毒力攜帶者菌血癥腦脊髓膜化膿性性腦膜炎其他器官心包或關(guān)節(jié)等

meningococcalmeningitisPathogenesis內(nèi)毒素小血管瘀斑感染性休克DIC出血腦水腫腦部化膿昏迷腦疝meningococcalmeningitisAnato-PathologySepticemiastage血管內(nèi)皮損害心肌炎和肺水腫血管壁炎癥、壞死血栓形成、血管周?chē)鲅つw粘膜出血臟器出血Anatomie-Pathologiquemeningococcalmeningitis

Anato-PathologyMeningitisstage軟腦膜和蛛網(wǎng)膜血管充血、出血、水腫顱壓升高FP、NE、Plasma外滲CSF混濁顱底炎癥、粘連顱神經(jīng)損害meningococcalmeningitismeningococcalmeningitisAnato-PathologyMeningitisstage爆發(fā)型腦實(shí)質(zhì)壞死、充血、出血、水腫顱壓↑腦疝慢性病人腦室孔阻塞CSF循環(huán)障礙腦積水meningococcalmeningitismeningococcalmeningitisClinicalManifestationTheaverageincubationperiodvariesfrom1-10days(2~3days).meningococcalmeningitisClinicalManifestationOrdinarytype(>90%cases)Nasopharynxrestrictedstage持續(xù)1~2天上呼吸道感染表現(xiàn)多數(shù)病人無(wú)此期表現(xiàn)Septicaemiastage急起高熱39~40℃頭痛皮膚粘膜淤點(diǎn)淤斑meningococcalmeningitismaculopapularrashmeningococcalmeningitisClinicalManifestationOrdinarytypeMeningitisstage多與敗血癥同時(shí)出現(xiàn)中樞神經(jīng)系統(tǒng)病癥腦膜刺激癥意識(shí)障礙、抽搐持續(xù)2~5天Convalescencestage體溫下降，病癥消失幸福皰疹meningococcalmeningitisClinicalManifestationFulminantTypeShockType典型腦膜炎急性表現(xiàn)瘀點(diǎn)瘀斑廣泛，融合休克表現(xiàn)腦膜刺激癥可缺如腦脊液不典型，但培養(yǎng)多陽(yáng)性meningococcalmeningitismeningococcalmeningitisClinicalManifestationFulminantTypeMeningo-encephalitis腦實(shí)質(zhì)損害腦疝枕骨大孔疝:又稱(chēng)小腦扁桃體疝.幕下的小腦扁桃體及延髓經(jīng)枕骨大孔被擠向椎管內(nèi)以延髓急性損害病癥為主,生命體征改變.天幕裂孔疝:又稱(chēng)小腦幕切跡疝.幕上的腦組織(顳葉的海馬回、鉤回)通過(guò)小腦幕切跡被擠向幕下.初起時(shí)病側(cè)瞳孔略縮小，光反響稍遲鈍，以后病側(cè)瞳孔逐漸散大，略不規(guī)那么，直接及間接光反響消失，健側(cè)肢體癱瘓。MixedtypemeningococcalmeningitismeningococcalmeningitisClinicalManifestationMildTypefever,jointpainandsymptomsofanupperrespiratoryinfection.LessrashChildrenandOldmanmeningococcalmeningitisLabBloodroutineWBC↑↑↑，NE↑↑CSF混濁，WBC>1000X106/L，多核為主Pr↑,Glu↓Cl-↓顱壓↑meningococcalmeningitisLUMBERPUNCTUREmeningococcalmeningitisLabBacteriology涂片meningococcalmeningitisLabBacteriology培養(yǎng)meningococcalmeningitisLabImmunologyAntigeneAntibodyOthersCSF-β2-microglobulinCST-LDHmeningococcalmeningitisComplicationsandpersistingsequelaeDiagnosisanddifferentdiagnosisDiagnosis季節(jié)，突發(fā)高熱，頭痛，嘔吐瘀斑，腦膜刺激癥血、腦脊液檢查，細(xì)菌培養(yǎng)Differentdiagnosis其他細(xì)菌病毒腦，結(jié)