腦炎與腦膜炎課件

腦炎與腦膜炎中樞神經(jīng)系統(tǒng)感染

(腦炎與腦膜炎)腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎腦炎與腦膜炎PCR應(yīng)用于中樞神經(jīng)系統(tǒng)感染HerpessimplexvirusI(HSencephalitis)HerpessimplexvirusII(新生兒HSE,復(fù)發(fā)性腦膜炎)JCvirus(進行性多灶白質(zhì)腦病)Cytomegalovirus(CMV室管膜炎及伴AIDS

的多神經(jīng)根病)結(jié)核菌(結(jié)核性腦膜炎)Borrelliaburgdorferi(萊姆病)Tropherymawhippelii(CNSWhipple’s病)腦炎與腦膜炎化膿性腦膜炎(1)致病原發(fā)病率(%)新生兒

B族鏈球菌60Escherichiacoli,其他腸道格蘭氏陰性菌30Candidaalbicans5Listeriamonocytogenes2

其他3嬰兒

Hemophilusinfluenzae,typeb60Neisseriameningitidis25Streptococcuspneumoniae15腦炎與腦膜炎化膿性腦膜炎(2)致病原發(fā)病率(%)成人

Streptococcuspneumoniae40Neisseriameningitidis30Escherichiacoli,othergram-negativeentericorganisms10Listeriamonocytogenes5

其他15腦炎與腦膜炎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腦炎與腦膜炎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.腦炎與腦膜炎腦膜炎1.細菌性腦膜炎包括化膿性腦膜炎、結(jié)核性腦膜炎、螺旋體感染引起的腦膜炎2.真菌性腦膜炎3.支原體腦膜炎3.病毒性4.寄生蟲性腦膜炎腦炎與腦膜炎EmpiricAntimicrobialTherapyofBacterialMeningitis(1)

Children

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

plus

Ampicillin12g/dayIVindivideddosesevery4hwhenindicated 腦炎與腦膜炎EmpiricAntimicrobialTherapyofBacterialMeningitis(2)NeurosurgicalprocedureCeftriaxoneorcefotaximeorceftazidime(Fortum)6g/day

IV(forcoverageofPaeruginosa)individeddosesevery8hplusGentamicinortobramycin1.5mg/kgevery8hIVplusOxacillin12gldayIV(individeddosesevery4h)orVancomycin2g/dayIV(individeddosesevery6b)AlcoholismCefotaximeorceftriaxoneplusVancomycinplusAmpicillin腦炎與腦膜炎EmpiricAntimicrobialTherapyofBacterialMeningitis(3)

Diabetesmellitus

CefotaximeorceftnaxoneplusVancomycinNeutropeniaCeftriaxoneorcefotaximeorceftazidime(forPaeruginosa)plusVancomycinOrgantransplantrecipientand/orimmunosuppressivetherapyAmpicillinplusceftazidimeCancer

CefotaximeorceftriaxoneplusAmpicillinplusVancomycin

腦炎與腦膜炎建議應(yīng)用抗菌素的期間病原建議治療時間(日)H.influenzae7N.meningitidis7S.Pneumoniae10-14L.Monocytogenes14-21GroupBstreptococci14-21Gram(-)bacilli(除流感桿菌外)21腦炎與腦膜炎TreatmentofTuberculousMenigitis(1)Child1.Isoniazid10-15mg/kg/day2.Rifampin10-20mg/kg/day3.Pyrazinamide20-40mg/kg/day4.Sreptomycin20-40mg/kg/day5.±Corticosteroids6.±VPshunt腦炎與腦膜炎TreatmentofTuberculousMenigitis(2)Immunocompetentadult1.Isoniazid5mg/kg/day2.Rifampin10mg/kg/day3.Pyrazinamide15-30mg/kg/day4.Pyridoxine50mg/day5.±Ethambutolorstreptomycin6.±Corticosteroids7.±VPshunt腦炎與腦膜炎TreatmentofTuberculousMenigitis(3)Immunosuppressed