流行性脑脊髓膜炎epidemiccerebrospinalmeningitis

1、 流行性脑脊髓膜炎 epidemic cerebrospinal meningitis1概述病原学 脑膜炎奈瑟菌 内毒素是其重要的致病因素 可产生自溶酶 分13群：A B C D 29E H I K W135 X Y Z2流脑病人脑脊液革兰染色可见成双排列的革兰阴性双球菌。3流行病学（一）传染源：病人 带菌者（二）传播途径：呼吸道飞沫（三）人群易感性：儿童发病率高（四）流行特征：冬春季多发 周期性流行4发病机制隐性感染带菌者菌血症皮肤淤点败血症发热等脑脊髓膜化脓性炎症细菌 鼻咽部5败血症期细菌皮肤粘膜血管内皮细胞内繁殖引起出血坏死（淤点 淤斑）释放内毒素大量内毒素全身小血管痉挛微循环障碍有效循

2、环血量减少（感染性休克）血流缓慢血细胞凝聚 加上血管内皮细胞损伤 组织损伤激活凝血系统DIC加重微循环障碍出血 MOF6脑膜炎期脑膜脊髓膜血管内皮细胞坏死 血管通透性增加血浆外渗 水肿 重者脑实质亦有炎症内毒素脑微循环障碍缺氧 水肿 出血昏迷 抽搐 脑疝78临床表现（一）普通型 1、前驱期（上呼吸道感染期） 2、败血症期 3、脑膜炎期 4、恢复期91011（二）暴发型 1、休克型 fulminant meningococcal septicemia acute respiratory distress syndrome 2、脑膜脑炎型 3、混合型（三）轻型（四）慢性脑膜炎双球菌败血症12实验室

3、检查（一）血象 WBC升高 （1020）109/L（二）CSF（三）细菌学检查 1、凃片 2、培养（四）免疫学检查 特异性抗原、抗体 13诊断1、流行病学资料2、临床表现3、实验室检查14 肺炎链球菌 streptococcus pneumoniae 流感嗜血杆菌 haemophilus influenzae 金黄色葡萄球菌 staphylococcus aureus（2）结核性脑膜炎（3）流行性乙型脑炎2、其他病原菌引起的败血症休克鉴别诊断1、其他病原体引起的中枢神经系统感染（1）其他细菌引起的化脓性脑膜炎15治疗（一）普通型的治疗 1、一般治疗 2、病原治疗 青霉素G 首选 磺胺嘧啶 氯霉

4、素 三代头孢菌素 3、对症治疗 16（二）暴发型的治疗 1、休克型的治疗 抗菌药 纠正休克 肾上腺皮质激素 DIC治疗 保护重要脏器功能 2、脑膜脑炎型的治疗 抗菌药 防治脑水肿、脑疝、呼吸衰竭 肾上腺皮质激素17预防（一）管理传染源（二）切断传播途径（三）提高人群免疫力 A群多糖菌苗 双价菌苗 四价菌苗18Meningococcal InfectionsMeningococcal infections are a major cause of mortality and morbidity in developed and developing nations. Neisseria meni

5、ngitidis is the causative agent in meningococcal infections. It has become the most common cause of bacterial meningitis in American children since the use of the Haemophilus influenzae type b protein-capsular polysaccharide conjugate vaccine in infants dramatically reduced their incidence of mening

6、itis due to this organism. Considerable progress has been made in the management and prevention of infections due to Neisseria meningitidis since the organism was first described in 1887. Because the meningococcal vaccine has limited effectiveness in the group at greatest risk to infection, 19childr

7、en younger than the age of 2, meningococcal infection is still a major worldwide problem. The devastating nature of systemic meningococcal infection makes it imperative that preventive measures be developed to fully control this disease. In addition, an effective vaccine against meningococcal serogroup B infection has not been developed. Until this goal is realized, it is crucial that the clinician recognize and be able to successfull