脑炎与脑膜炎课件

脑炎与脑膜炎中枢神经系统感染

(脑炎与脑膜炎)脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎脑炎与脑膜炎PCR应用于中枢神经系统感染HerpessimplexvirusI(HSencephalitis)HerpessimplexvirusII(新生儿HSE,复发性脑膜炎)JCvirus(进行性多灶白质脑病)Cytomegalovirus(CMV室管膜炎及伴AIDS

的多神经根病)结核菌(结核性脑膜炎)Borrelliaburgdorferi(莱姆病)Tropherymawhippelii(CNSWhipple’s病)脑炎与脑膜炎化脓性脑膜炎(1)致病原发病率(%)新生儿

B族链球菌60Escherichiacoli,其他肠道格兰氏阴性菌30Candidaalbicans5Listeriamonocytogenes2

其他3婴儿

Hemophilusinfluenzae,typeb60Neisseriameningitidis25Streptococcuspneumoniae15脑炎与脑膜炎化脓性脑膜炎(2)致病原发病率(%)成人

Streptococcuspneumoniae40Neisseriameningitidis30Escherichiacoli,othergram-negativeentericorganisms10Listeriamonocytogenes5

其他15脑炎与脑膜炎CerebrospinalFluidAbnormalitiestoDistinguish

ViralfromBacterialMeningitisCharacteristicViral

BacterialOpeningpressure Normalormildlyelevated

250mmR2OCellcount 200-2000cells/mm3

100cells/mm3 LymphocyticpleocytosisPolymorphonuclear pleocytosisProteinconcentrationNormalormildlyelevated

45mg/dlGlucoseconcentration

40mg/dl

40mg/dlCSF:Serumglucoseratio

0.31

0.31Gram'sstain Negative PositiveLacticacidconcentration

35mg/dl

35mg/dl脑炎与脑膜炎ManagementofIncreasedIntracranialPressure

1. Elevatetheheadofthebed30o2. HyperventilationtomaintainPaCO2between25-30mmHg*3. Hyperosmolartherapy-mannitolLoadingdose:1.0g/kgbolusinjectionMaintenancedose:0.25-0.5g/kgevery3-5htoachieveserumosmolarityof295-320mOsm/liter4. PentobarbitalcomaLoadingdose:5-10mg/kgIVatarateof1mg/kg/minMaintenancedose:1-3mg/kg/h.Titratedosetoachieveatherapeuticserumconcentrationof25-40μg/d1oraburst-suppressionpatternonEEG*HyperventilationmaycompromisecerebralperfusionresultingincerebralisehemiaifPaCO2isloweredbelow25mmHg.脑炎与脑膜炎脑膜炎1.细菌性脑膜炎包括化脓性脑膜炎、结核性脑膜炎、螺旋体感染引起的脑膜炎2.真菌性脑膜炎3.支原体脑膜炎3.病毒性4.寄生虫性脑膜炎脑炎与脑膜炎EmpiricAntimicrobialTherapyofBacterialMeningitis(1)

Children

Ceftriaxone(Rocephin)100mg/kg/dayIVinaonceortwicedailydosingintervalorCefotaxime(Claforan)225mg/kg/dayIVindivideddosesevery8hplusVancomycin40mg/kg/dayIVindivideddosesevery6hAdultsCommunity-acquiredCeftriaxone2gIVevery12horCefotaxime8-12g/dayIV(individeddosesevery4h)plusVancomycin2g/dayIVindivideddosesevery6h

plus

Ampicillin12g/dayIVindivideddosesevery4hwhenindicated 脑炎与脑膜炎EmpiricAntimicrobialTherapyofBacterialMeningitis(2)NeurosurgicalprocedureCeftriaxoneorcefotaximeorceftazidime(Fortum)6g/day

IV(forcoverageofPaeruginosa)individeddosesevery8hplusGentamicinortobramycin1.5mg/kgevery8hIVplusOxacillin12gldayIV(individeddosesevery4h)orVancomycin2g/dayIV(individeddosesevery6b)AlcoholismCefotaximeorceftriaxoneplusVancomycinplusAmpicillin脑炎与脑膜炎EmpiricAntimicrobialTherapyofBacterialMeningitis(3)

Diabetesmellitus

CefotaximeorceftnaxoneplusVancomycinNeutropeniaCeftriaxoneorcefotaximeorceftazidime(forPaeruginosa)plusVancomycinOrgantransplantrecipientand/orimmunosuppressivetherapyAmpicillinplusceftazidimeCancer

CefotaximeorceftriaxoneplusAmpicillinplusVancomycin

脑炎与脑膜炎建议应用抗菌素的期间病原建议治疗时间(日)H.influenzae7N.meningitidis7S.Pneumoniae10-14L.Monocytogenes14-21GroupBstreptococci14-21Gram(-)bacilli(除流感杆菌外)21脑炎与脑膜炎TreatmentofTuberculousMenigitis(1)Child1.Isoniazid10-15mg/kg/day2.Rifampin10-20mg/kg/day3.Pyrazinamide20-40mg/kg/day4.Sreptomycin20-40mg/kg/day5.±Corticosteroids6.±VPshunt脑炎与脑膜炎TreatmentofTuberculousMenigitis(2)Immunocompetentadult1.Isoniazid5mg/kg/day2.Rifampin10mg/kg/day3.Pyrazinamide15-30mg/kg/day4.Pyridoxine50mg/day5.±Ethambutolorstreptomycin6.±Corticosteroids7.±VPshunt脑炎与脑膜炎TreatmentofTuberculousMenigitis(3)Immunosuppressed