（实用课件）化脓性脑膜炎(英文版)

1、Purulent Meningitis Purulent Meningitis Acute infection of central nervous system (CNS). 90% of cases occur in the age of 1mo-5yr. The inflammation of meninges caused by various bacteria. Common features in clinical practices include: fever, increased intracranial pressure, meningeal irritation. One

2、 of the most potentially serious infections, associated with high mortality (about 10%) and morbidity. Acute infection of central ne Pathogens:Main pathogens: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae. (2/3 of purulent meningitis are caused by these pathogens)Pathogens

3、 in special populations (neonates & 3mo infants , malnutrition, immunodeficiency): gramnegative enteric bacilli, group B streptococci, staphlococcus aureus1.Etiology Pathogens:1.Etiology2. Pathology Structure of meninges 2. Pathology Characterized by leptomeningeal and perivascular infiltration with

4、 polymorphonuclear leukocytes and inflammatory exudate. Exudate which may be distributed from convexity of brain to basal region of cranium.Pathology Characterized by leptomeninge The younger the child is, the higher incidence of meningitis will be. 1/2-2/3 of cases occur less than 1yr of age. Mode

5、of presentation: Acute or fulminant onset: symptoms and signs of sepsis; meningitis evolve rapidly over a few hours and death within 24 hours; usually infected with Neisseria meningitidis (N. meningitidis). Subacute onset: Precede by several days of upper respiratory tract or gastrointestinal sympto

6、ms; difficult to pinpoint the exact onset of meningitis; usually with meningitis due to Haemophilus influenzae (H influenzae) and streptococcus pneumococcus (S pneumococcus). 3. Clinical manifestations3. Clinical manifestations Common features of meningitis: signs of systemic infection : fever(90-95

7、%), anorexia, shock, alteration of mental status and consciousness neurological signs: increased intracranial pressure: headache, vomiting(82%), herniation meningeal irritation: nuchal rigidity(77%), kernig sign, brudzinski sign Clinical manifestations Common features of meningitisA positive Brudzin

8、skis sign (flexion of the hips and knees in response to passive flexion of the neck) signals meningeal irritation. Passive flexion of the neck stretches the nerve roots, causing pain and involuntary flexion of the knees and hips. Kernigs sign elicits resistance and hamstring muscle pain when the exa

9、miner attempts to extend the knee while the hip and knee are flexed 90 degrees A positive Brudzinskis sign ( Seizure (20-30%) Focal or generalized Due to cerebritis, infarction, electrolyte disturbances Frequently noted with Haemophilus influenzae & Streptococcus pneumococcal meningitis Clinical man

10、ifestations Seizure (20-30%) Clinical m Clinical manifestations Alteration of mental status and consciousness Including: irritability, lethargy, stupor and coma Due to increased intracranial pressure, cerebritis, hypotension Often with pneumococcal or meningococcal meningitis Clinical manifestations

11、 A The symptoms and signs are not evident in neonates or infants younger than 3mo of age or patients already received irregular antibiotic therapy.Clinical manifestations The symptoms and signs are no Earlier diagnosis and prompt initiation of effective antibiotic treatment is critical for minimizin

12、g sequelae of purulent meningitis. Suspected cases: febrile infants with seizure, meningeal irritability, increased intracranial pressure, altered mental status Pay attention to the atypical symptoms and signs in neonates, infants and patients already received antibiotic therapy 4. Diagnosis4. Diagn

13、osisDiagnosis is confirmed by analysis of cerebrospinal fluid ( CSF) DiagnosisLumber punctureDiagnosis is confirmed by analDiagnosis Suggestion bacterial meningitis Increased pressure (90%) Appearance: slightly cloudy to purulent Raised white blood cells, consisting chiefly of polymorphonuclear leuk

14、ocytes Raised protein concentration, decreased glucose concentration (80%) analysis of cerebrospinal fluid ( CSF)Diagnosis Suggestion bacter Viral meningitis: Less severe systemic infectious symptoms Usually not develop after 2-3weeks CSF: normal glucose 5. Differential diagnosis Viral meningitis: 5

15、. Diff Tuberculous meningitis Subacute onset and progress A history of close contact with known cases of tuberculosis Evidence of acute or healed tubercular infection on chest x-ray Tuberculin skin test : PPD CSFDifferential diagnosis Tuberculous meningitisDiffeDiseasePressure(Kpa)aspectTotal WBC(x1

16、06/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)Grams stain +TuberculousmeningitisNormal or cloudy(MN)AFB stain +Viral meningitis/encephalitisNormal or Normal Normal or (MN)Normal or (2ml, protein0.4

17、g/L6. Complications6.1 Subdural effusion6. Compli Indications: No response to a sensitive antibiotic therapy Prolonged fever or fever reoccurring after an afebrile interval with effective treatment Bulging fontanel, widening of sutures, enlarging head circumference, emesis, seizure and altered consc

18、iousness. may be diagnosed by the examination of CT or MRI and subdural puncture. subdural effusion Indications: subdural effu Diagnosis methods:subdural effusion Subdural puncture CT Diagnosis methods:subdural ef6.2 Ependymitis Usually occurs in neonates and infants (50 x106/L, glucose400mg/L.Epend

19、ymitistransorbital puncture of the lateral ventricles Diagnosis:EpendymitistransorbComplications6.3 hydrocephalus T2-weighted MRIshowing dilatation of ventricles out of proportion to sulcal atrophy Complications6.3 hydrocephalus6.4 syndrome of inappropriate secretion of antidiuretic hormone; SIADACo

20、mplicationshyponatremiaplasma osmotic pressurecerebral edemaseizureconscious disturbancecomaClinical menifeststion:6.4 syndrome of inappropriateComplications6.5 cerebral abscess Complications6.5 cerebral absc6.6 others: Deafness, blindness, paralysis, epilepsy, mental retardationComplicationsComplic

21、ations7.1 Antibacterial therapy TreatmentTherapy principlesearly treatmentsusceptible to pathogens high permeability through BBBgiven intraveninouslyenough doseenough course 7.1 Antibacterial therapy Trea Susceptible to pathogens First choice: Cefotaxime, Ceftriaxone (3dr generation of cephalosporins, high permeability through BBB) Other choice: Penicillin, Chloromycin, Cefuroxime, Ceftazidime ( delayed effect to make CSF sterile, high incidence