化膿性腦膜炎英文版培訓(xùn)課件

1、化膿性腦膜炎英文版化膿性腦膜炎英文版 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 of the most potentiall

2、y serious infections, associated with high mortality (about 10%) and morbidity. Purulent Meningitis化膿性腦膜炎英文版2 Acute infection of central neEtiology1.1 Pathogens:Main pathogens: Neissria meningitidis, streptoccus pneumoniae, Haemophilus influenzae. (2/3 of purulent meningitis are caused by these path

3、ogens)Pathogens in special populations (neonate & 3mo infants , malnutrition, immunodeficiency): gramnegative enteric bacilli, group B streptococci, staphlococcus aureus 化膿性腦膜炎英文版3Etiology化膿性腦膜炎英文版31.2 Major risk factors for meningitis Immature immunologic function and attenuated immunologic respons

4、e to pathogens Low level of immunoglobulin, defects of complement and properdin system Immature or impaired blood-brain-barrier (BBB) Immature BBB function: maturation at about 1yr Impaired BBB: Congenial or acquired defects across mucocutaneous barrier 化膿性腦膜炎英文版41.2 Major risk factors for me 1.3 Ac

5、cess of bacteria invasion Typical access-hematogenous dissemination Bacteria colonizing the mucous membranes of the nasopharynx invasion into local tissue bacteremia hematogenous seeding to the subarachnoid space Mode of transmission: Person to person contact through respiratory tract secretions or

6、droplets化膿性腦膜炎英文版5 1.3 Access of bacteria invas Bacteria spread to the meninges directly: through anatomic defects in the skull or head trauma Invasion from parameningeal organs: such as paranasal sinuses or middle earAccess of bacteria invasion化膿性腦膜炎英文版6 Bacteria spread to the mening2. Pathology St

7、ructure of meninges 化膿性腦膜炎英文版72. Pathology化膿性腦膜炎英文版7 Characterized by leptomeningeal and perivascular infiltration with polymorphonuclear leukocytes and an inflammatory exudate.Exudate which may be distributed from convexity of brain to basal region of cranium. Exudate is more thickness due to strep

8、tococcus pneumoniae than other pathogens.Pathology化膿性腦膜炎英文版8 Characterized by leptomeninge3. Clinical manifestations The younger the child is, the higher incidence of meningitis will be. -2/3 of cases occur less than 1yr of age. Mode of presentation: Acute or fulminant onset: symptoms and signs of s

9、epsis; meningitis evolve rapidly over a few hours and death within 24 hours; usually infected with Neissria meningitides (N. meningitides). 化膿性腦膜炎英文版93. Clinical manifestations化膿性腦 Subacute onset: Precede by several days of upper respiratory tract or gastrointestinal symptoms; difficult to pinpoint

10、the exact onset of meningitis; usually with meningitis due to Haemophilus influenzae (H influenzae) and streptoccus pneumococcus (S pneumococcus).Mode of presentation化膿性腦膜炎英文版10 Subacute onset: Mode of prese Common features of meningitis: signs of systemic infection : fever(90-95%), anorexia,shock,

11、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化膿性腦膜炎英文版11 Common features of meningitisbrudzinski sign化膿性腦膜炎英文版12br

12、udzinski sign化膿性腦膜炎英文版12 Seizure (20-30%) Focal or generalized Due to cerebritis, infarction, electrolyte disturbances Frequently noted with H influenzae & S pneumococcal meningitis Persist after 4th day and difficult to treat with poor prognosisClinical manifestations化膿性腦膜炎英文版13 Seizure (20-30%) Cl

13、inical m Clinical manifestations Alteration of mental status and consciousness Including: irritability, lethargy, stupor obtundation, coma Due to increased intracranial pressure, cerebritis, hypotension Often with pneumococcal or meningococcal meningitis Comatose patients with a poor prognosis化膿性腦膜炎

14、英文版14 Clinical manifestations A The symptoms and signs are not evident in neonates and infants younger than 3mo of age; and patients already received irregular antibiotic therapy.Clinical manifestations化膿性腦膜炎英文版15 The symptoms and signs are noSigns of systemic infectionIncreased intracranial pressur

15、emeningeal irritationTypical(older children)Fever, altered consciousness, seizureHeadache, vomiting, herniationnuchal rigidity, back pain, kernig sign, brudzinski signAtypical(neonate & 3mo infant )Fever,normal temperature or hypothermia; minim or subtle seizure; poor feeding;less activityScream,fro

16、wn;bulging or full fontanel; widening of the suturesNot evidentComparison of the manifestations of meningitis between different age groupsClinical manifestations化膿性腦膜炎英文版16Signs of systemic infectionInc4. Diagnosis Earlier diagnosis and prompt initiation of effective antibiotic treatment is critical

17、 for minimizing 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 neonate, infant and patient already received irregular antibiotic therapy

18、 化膿性腦膜炎英文版174. Diagnosis化膿性腦膜炎英文版17 Diagnosis is confirmed by analysis of cerebrospinal fluid ( CSF) Suggestion bacterial meningitis Increased pressure (90%) Appearance: slightly cloudy to purulent Raised white blood cells,consisting chiefly of polymorphonuclear leukocytes Raised protein concentrati

19、on, decreased glucose concentration (80%) Diagnosis化膿性腦膜炎英文版18 Diagnosis is confirmed by ana Confirmation of the diagnosis: isolation from the CSF of a specific bacterial pathogen by microscopy or a positive culture or rapid antigen- detection test of CSF Gram-stained smear of CSF: identify the caus

20、ative organism in 70-90% of cases CSF culture: positive in about 80% of cases. definitive diagnosis, determination of antibiotic sensitivity. PCR: amplifies bacterial DNA (H influenzae, N. meningitidis)Diagnosis化膿性腦膜炎英文版19 Confirmation of the diagnosi5. Differential diagnosis Purulent meningitis cau

21、sed by different pathogens Neissria meningitidis: Occur in epidemics (type A,C), which is more common in spring, or sporadic all the year (type B,C,Y) Sudden onset with various cutaneous signs ( petechiae, purpura, or an erythematous macular rash) 化膿性腦膜炎英文版205. Differential diagnosis化膿性腦膜 Streptococ

22、cus pneumoniae: Young infants ( 1yr) are most susceptible population Peak season: spring and winter Easier to have subdural effusion and hydrocephalus Easily have a protracted course and relapseDifferential diagnosis化膿性腦膜炎英文版21 Streptococcus pneumoniae:Di Haemophilus influenzae Occurs predominantly

23、in infants 2mo to 2yr of age Many cases are in winter Higher incidence of subdural effusion Others pathogens: staphylococcus aureus, gramnegative enteric bacilli Special susceptible population: neonate, 3mo infants, malnutrition, immunodeficiency Severe infection, difficult to treatDifferential diag

24、nosis化膿性腦膜炎英文版22 Haemophilus influenzae Differ Meningitis caused by other microorganisms Viral meningitis/encephalitis: Less severe systemic infectious symptoms Usually not develop after 2-3weeks CSF: normal glucose Differential diagnosis化膿性腦膜炎英文版23 Meningitis caused by other mi Tuberculous meningit

25、is 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 : OT, PPD CSFDifferential diagnosis化膿性腦膜炎英文版24 Tuberculous meningitisDiffeDiseasePressure(Kpa)aspectTotal WBC(x106/L)Protein

26、(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, protein0.4g/L, Inciden

27、ce: develop in 10-30% of patients, asymptomatic in 85-90% of patients; especially common in infants 4-6 month of age ( rare in children over 1yr); 化膿性腦膜炎英文版266. Complications and sequelae化 Causative organisms: 45% of cases of meningitis caused by H influenzae, 30% by S pneumoniae, 9% by N meningitid

28、issubdural effusion化膿性腦膜炎英文版27 Causative organisms: 45% of 化膿性腦膜炎英文版培訓(xùn)課件 Diagnosis methods: Cranial translucent test B ultrasonic examination and CT Subdural space puncture subdural effusionnormalsubdural effusion化膿性腦膜炎英文版29 Diagnosis methods:subdural ef6.2 Ventriculitis6.3 hydrocephalusComplication

29、s化膿性腦膜炎英文版306.2 Ventriculitis6.3 hydrocepCirculation of cerebrospinal fluid(CSF)化膿性腦膜炎英文版31Circulation of cerebrospinal f6.2 Ventriculitis Usually occurs in neonates and infants (50 x106/L, Glucose400mg/L.Ventriculitis化膿性腦膜炎英文版33 Diagnosis:Ventriculitis化膿性腦膜炎Circulation of cerebrospinal fluid(CSF)化膿

30、性腦膜炎英文版34Circulation of cerebrospinal f6.3 hydrocephalus : Communicating hydrocephalus: adhered or destroyed arachnoid granulation around the cistern at the base of the brain Obstructive hydrocephalus: following obstructed of the cerebral aqueduct, or the foramina of Magendie and Luschka6.4 others:

31、Deafness, blindness, paralysis, epilepsy, mental retardationComplications化膿性腦膜炎英文版356.3 hydrocephalus :Complicatio Treatment7.1 Antibacterial therapyTherapy principles: early treatment, antibiotics susceptible to pathogens and with high permeability through BBB, given intraveninously, enough dose, e

32、nough course of antibiotic therapy 化膿性腦膜炎英文版36 Treatment化膿性腦膜炎英文版36 Susceptible to pathogens First choice: Cefotaxime, Ceftriaxone (3dr generation of cephalosporins, high permeability through BBB, products of metabolism also has effect, CSF sterilization within 24h) Other choice: Penicillin, Chlorom

33、ycin, Cefuroxime, Ceftazidime ( delayed effect to make CSF sterile, high incidence of relapse and deafness)Antibacterial therapy化膿性腦膜炎英文版37 Susceptible to pathogensAntiEtiologyStandard antibiotics of choiceDuration of therapyH.influenzaeCefotaxime /Ceftriaxone7-10daysN.meningitidisCefotaxime /Ceftriaxone7daysS.pneumoniaeCefotaxime /Ceftriaxone2-3weeksStaphlococcus aureusSemisynthetic penicillins (Oxacillin sodium, Cloxacillin sodium),Norvancomycin3weeks