化脓性脑膜炎(英文)VIP专享VIP免费

PurulentMeningitisinChildrenJiangLiDepartmentofNeurologyChildren’sHospitalChongqingUniversityofMedicalSciencesAcuteinfectionofcentralnervoussystem(CNS).90%ofcasesoccurintheageof1mo-5yr.Theinflammationofmeningescausedbyvariousbacteria.Commonfeaturesinclinicalpracticesinclude:fever,increasedintracranialpressure,meningealirritation.Oneofthemostpotentiallyseriousinfections,associatedwithhighmortality(about10%)andmorbidity.PurulentMeningitis1.Etiology1.1Pathogens:Mainpathogens:Neissriameningitidis,streptoccuspneumoniae,Haemophilusinfluenzae.(2/3ofpurulentmeningitisarecausedbythesepathogens)Pathogensinspecialpopulations(neonate&<3moinfants,malnutrition,immunodeficiency):gramnegativeentericbacilli,groupBstreptococci,staphlococcusaureus1.2MajorriskfactorsformeningitisImmatureimmunologicfunctionandattenuatedimmunologicresponsetopathogensLowlevelofimmunoglobulin,defectsofcomplementandproperdinsystemImmatureorimpairedblood-brain-barrier(BBB)ImmatureBBBfunction:maturationatabout1yrImpairedBBB:Congenialoracquireddefectsacrossmucocutaneousbarrier1.3AccessofbacteriainvasionTypicalaccess---hematogenousdisseminationBacteriacolonizingthemucousmembranesofthenasopharynxinvasionintolocaltissuebacteremiahematogenousseedingtothesubarachnoidspaceModeoftransmission:PersontopersoncontactthroughrespiratorytractsecretionsordropletsBacteriaspreadtothemeningesdirectly:throughanatomicdefectsintheskullorheadtraumaInvasionfromparameningealorgans:suchasparanasalsinusesormiddleearAccessofbacteriainvasion2.PathologyStructureofmeningesCharacterizedbyleptomeningealandperivascularinfiltrationwithpolymorphonuclearleukocytesandaninflammatoryexudate.Exudatewhichmaybedistributedfromconvexityofbraintobasalregionofcranium.Exudateismorethicknessduetostreptococcuspneumoniaethanotherpathogens.Pathology3.ClinicalmanifestationsTheyoungerthechildis,thehigherincidenceofmeningitiswillbe.½-2/3ofcasesoccurlessthan1yrofage.Modeofpresentation:Acuteorfulminantonset:symptomsandsignsofsepsis;meningitisevolverapidlyoverafewhoursanddeathwithin24hours;usuallyinfectedwithNeissriameningitides(N.meningitides).Subacuteonset:Precedebyseveraldaysofupperrespiratorytractorgastrointestinalsymptoms;difficulttopinpointtheexactonsetofmeningitis;usuallywithmeningitisduetoHaemophilusinfluenzae(Hinfluenzae)andstreptoccuspneumococcus(Spneumococcus).ModeofpresentationCommonfeaturesofmeningitis:signsofsystemicinfection:fever(90-95%),anorexia,shock,alterationofmentalstatusandconsciousnessneurologicalsigns:increasedintracranialpressure:headache,vomiting(82%),herniationmeningealirritation:nuchalrigidity(77%),kernigsign,brudzinskisignClinicalmanifestationsbrudzinskisignSeizure(20-30%)FocalorgeneralizedDuetocerebritis,infarction,electrolytedisturbancesFrequentlynotedwithHinfluenzae&SpneumococcalmeningitisPersistafter4thdayanddifficulttotreatwithpoorprognosisClinicalmanifestationsClinicalmanifestationsAlterationofmentalstatusandconsciousnessIncluding:irritability,lethargy,stuporobtundation,comaDuetoincreasedintracranialpressure,cerebritis,hypotensionOftenwithpneumococcalormeningococcalmeningitisComatosepatientswithapoorprognosisThesymptomsandsignsarenotevidentinneonatesandinfantsyoungerthan3moofage;andpatientsalreadyreceivedirregularantibiotictherapy.Clinicalmanifestatio...