儿科英文化脓性脑膜炎讲稿.ppt

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1、儿科英文课件化脓性脑膜儿科英文课件化脓性脑膜炎炎第一页，讲稿共四十六页哦Introductionn nBacterial meningitis is an inflammation of the leptomenings,usually causing by bacterial infection.n nBacterial meningitis may present acutely(symptoms evolving rapidly over 1-24 hours),subacutely(symptoms evolving over 1-7days),or chronically(sympt

2、oms evolving over more than 1 week).第二页，讲稿共四十六页哦Introductionn nAnnual incidence in the developed countries is approximately 5-10 per 100000.n n30000 infants and children develop bacterial meningitis in United States each year.n nApproximately 90 per cent of cases occur in children during the first 5

3、 years of life.第三页，讲稿共四十六页哦Introductionn nCases under age 2 years account for almost 75%of all cases and incidence is the highest in early childhood at age 6-12 months than in any other period of life.n nThere are significant difference in the incidence of bacterial meningitis by season.第四页，讲稿共四十六页哦

4、Etiologyn nCausative organisms vary with patient age,with three bacteria accounting for over three-quarters of all cases:n nNeisseria meningitidis(meningococcus)n nHaemophilus influenzae(if very young and unvaccinated)n nStreptococcus pneumoniae(pneumococcus)第五页，讲稿共四十六页哦Etiologyn nOther organisms n

5、nNeonates and infants at age 2-3 months n nEscherichia coliEscherichia colin nB-haemolytic streptococciB-haemolytic streptococcin nStaphylococcus aureusStaphylococcus aureusn nStaphylococcusStaphylococcus epidermidisn nListeria monocytogenesListeria monocytogenes第六页，讲稿共四十六页哦Etiologyn nElderly and im

6、munocompromisedn nListeria monocytogenesListeria monocytogenesn nGram negative bacteriaGram negative bacterian nHospital-acquired infectionsn nKlebsiellaKlebsiellan nEscherichia coliEscherichia colin nPseudomonasPseudomonasn nStaphylococcus aureusStaphylococcus aureus第七页，讲稿共四十六页哦Etiologyn nThe most

7、common organisms n nNeonates and infants under the age of 2monthsn nEscherichia coli Escherichia coli n nPseudomonas Pseudomonas n nGroup B StreptococcusGroup B Streptococcusn nStaphylococcus aureusStaphylococcus aureus 第八页，讲稿共四十六页哦Etiologyn nChildren over 2 monthsn nHaemophilus influenzae type bn n

8、Neisseria meningitidisn nStreptococcus pneumoniaen nChildren over 12 yearsn nNeisseria meningitidisn nStreptococcus pneumoniae第九页，讲稿共四十六页哦Etiologyn nMajor routes of leptomening infectionn nBacteria are mainly from blood.n nUncommonly,meningitis occurs by direct extension from nearly focus(mastoiditi

9、s,sinusitis)or by direct invasion(dermoid sinus tract,head trauma,meningo-myelocele).第十页，讲稿共四十六页哦Pathogenesisn nSusceptibility of bacterial infection on CNS in the children n nImmaturity of immune systemsn nNonspecific immuneNonspecific immunen nInsufficient barrierInsufficient barrier(Blood-brain b

10、arrierBlood-brain barrier)n nInsufficient complement activityInsufficient complement activityn nInsufficient chemotaxis of neutrophilsInsufficient chemotaxis of neutrophilsn nInsufficient function of monocyte-macrophage systemInsufficient function of monocyte-macrophage systemn nBlood levels of dimi

11、nished interferon(INF)-and Blood levels of diminished interferon(INF)-and interleukin-8(IL-8)interleukin-8(IL-8)第十一页，讲稿共四十六页哦Pathogenesisn nSusceptibility of bacterial infection on CNS in the childrenn nSpecific immunen nImmaturity of both the cellular and humoral immune Immaturity of both the cellu

12、lar and humoral immune systemssystemsn nInsufficient antibody-mediated protectionInsufficient antibody-mediated protectionn nDiminished immunologic responseDiminished immunologic responsen nBacterial virulence 第十二页，讲稿共四十六页哦Pathogenesisn nA offending bacterium from blood invades the A offending bacte

13、rium from blood invades the leptomeninges.leptomeninges.n nBacterial toxics and Inflammatory mediators are Bacterial toxics and Inflammatory mediators are released.released.n nBacterial toxicsBacterial toxicsn nLipopolysaccharide,LPSLipopolysaccharide,LPSn nTeichoic acidTeichoic acidn nPeptidoglycan

14、 Peptidoglycan n nInflammatory mediatorsInflammatory mediatorsn nTumor necrosis factor,TNFTumor necrosis factor,TNFn nInterleukin-1,IL-1Interleukin-1,IL-1n nProstaglandin E2,PGE2Prostaglandin E2,PGE2第十三页，讲稿共四十六页哦Pathogenesisn nBacterial toxics and inflammatory mediators cause suppurative inflammatio

15、n.n nInflammatory infiltrationn nVascular permeability altern nTissue edema n nBlood-brain barrier detroyn nThrombosis 第十四页，讲稿共四十六页哦Pathologyn nDiffuse bacterial infections involve the leptomeninges,Diffuse bacterial infections involve the leptomeninges,arachnoid membrane and superficial cortical st

16、ructures,and arachnoid membrane and superficial cortical structures,and brain parenchyma is also inflamed.brain parenchyma is also inflamed.n nMeningeal exudate of varying thickness is found.Meningeal exudate of varying thickness is found.n nThere is purulent material around veins and venous sinuses

17、,There is purulent material around veins and venous sinuses,over the convexity of the brain,in the depths of the sulci,within over the convexity of the brain,in the depths of the sulci,within the basal cisterns,and around the cerebellum,and spinal cord the basal cisterns,and around the cerebellum,an

18、d spinal cord may be encased in pus.may be encased in pus.n nVentriculitis(purulent material within the ventricles)has Ventriculitis(purulent material within the ventricles)has been observed repeatedly in children who have died of been observed repeatedly in children who have died of their disease.t

19、heir disease.第十五页，讲稿共四十六页哦Pathologyn nInvasion of the ventricular wall with perivascular collections of purulent material,loss of ependymal lining,and subependymal gliosis may be noted.n nSubdural empyema may occur.Subdural empyema may occur.n nHydrocephalus is an common complication of meningitis.H

20、ydrocephalus is an common complication of meningitis.n nObstructive hydrocephalus Obstructive hydrocephalus n nCommunicating hydrocephalusCommunicating hydrocephalus 第十六页，讲稿共四十六页哦Pathologyn nBlood vessel walls may infiltrated by inflammatory cells.Blood vessel walls may infiltrated by inflammatory c

21、ells.n nEndothelial cell injuryEndothelial cell injuryn nVessel stenosisVessel stenosisn nSecondary ischemia and infarctionSecondary ischemia and infarctionn nVentricle dilatation which ensues may be associated with which ensues may be associated with necrosis of cerebral tissue due to the inflammat

22、ory process itself necrosis of cerebral tissue due to the inflammatory process itself or to occlusion of cerebral veins or arteries.or to occlusion of cerebral veins or arteries.第十七页，讲稿共四十六页哦Pathologyn nInflammatory process may result in cerebral edema and damage of the cerebral cortex.n nConscious

23、disturbanceConscious disturbancen nConvulsionConvulsionn nMotor disturbance Motor disturbance n nSensory disturbanceSensory disturbance n nMeningeal irritation sign is foundMeningeal irritation sign is found because the spinal nerve because the spinal nerve root is irritated.root is irritated.n nCra

24、nial nerve may be damaged第十八页，讲稿共四十六页哦Clinical manifestationn nBacterial meningitis may present acutely(symptoms evolving Bacterial meningitis may present acutely(symptoms evolving rapidly over 1-24 hours)in most cases.rapidly over 1-24 hours)in most cases.n nSymptoms and signs of upper respiratory

25、or gastrointestinal Symptoms and signs of upper respiratory or gastrointestinal infection are found before several days when the clnical infection are found before several days when the clnical manifestations of bacterial meningitis happen.manifestations of bacterial meningitis happen.n nSome patien

26、ts may access suddenly with shock and DIC.第十九页，讲稿共四十六页哦Clinical manifestationn nToxic symptom all over the body n nHyperpyrexiaHyperpyrexian nHeadacheHeadachen nPhotophobiaPhotophobian nPainful eye movementPainful eye movementn nFatigued and weak Fatigued and weak n nMalaise,myalgia,anorexia,Malaise

27、,myalgia,anorexia,n nVomiting,diarrhea and abdominal painVomiting,diarrhea and abdominal painn nCutaneous rashCutaneous rashn nPetechiae,purpuraPetechiae,purpura 第二十页，讲稿共四十六页哦Clinical manifestationn nClinical manifestation of CNSn nIncreased intracranial pressuren nHeadacheHeadachen nProjectile vomi

28、ting Projectile vomiting n nHypertension Hypertension n nBradycardia Bradycardia n nBulging fontanel Bulging fontanel n nCranial sutures diastasisCranial sutures diastasisn nComa Coma n nDecerebrate rigidity Decerebrate rigidity n nCerebral herniaCerebral hernia 第二十一页，讲稿共四十六页哦Clinical manifestationn

29、 nClinical manifestation of CNSn nSeizuresn nSeizures occur in about 20%-30%of children with bacterial meningitis.n nSeizures is often found in haemophilus influenzae and Seizures is often found in haemophilus influenzae and pneumococal infection.pneumococal infection.n nSeizuresSeizures is correlat

30、ive with the inflammation of brain is correlative with the inflammation of brain parenchyma,cerbral infarction and electrolyte parenchyma,cerbral infarction and electrolyte disturbances.disturbances.第一课件网站第一课件网站 第二十二页，讲稿共四十六页哦Clinical manifestationn nClinical manifestation of CNSn nConscious disturb

31、ancen nDrowsinessDrowsiness n nClouding of consciousness n nComaComan nPsychiatricPsychiatric symptomsymptom n nIrritation Irritation n nDysphoria Dysphoria n ndullnessdullness 第二十三页，讲稿共四十六页哦Clinical manifestationn nClinical manifestation of CNSn nMeningeal irritation signn nNeck stiffnessNeck stiff

32、nessn nPositive KernigPositive Kernig s signs signn nPositive BrudzinskiPositive Brudzinski s signs sign第二十四页，讲稿共四十六页哦Clinical manifestationn nClinical manifestation of CNSn nTransient or permanent paralysis of cranial nerves and limbs may be noted.n nDeafness or disturbances in vestibular function

33、are relatively common.n nInvolvement of the optic nerve,with blindness,is rare.n nParalysis of the 6th cranial nerve,usually transient,is noted frequently early in the course.第二十五页，讲稿共四十六页哦Clinical manifestationn nSymptom and signs of the infant under the age of 3 monthsSymptom and signs of the infa

34、nt under the age of 3 monthsn nIn some children,particularly young infants under the age of 3 In some children,particularly young infants under the age of 3 months,symptom and signs of meningeal inflammation may be months,symptom and signs of meningeal inflammation may be minimal.minimal.n nFever is

35、 generally present,but its absence or Fever is generally present,but its absence or hypothermiahypothermia in a infant in a infant with meningeal inflammation is common.with meningeal inflammation is common.n nOnly irritability,restlessness,dullnessOnly irritability,restlessness,dullness,vomiting,po

36、or feeding,vomiting,poor feeding,cyanosis,dyspnea,jaundice,seizures,shock and coma may be cyanosis,dyspnea,jaundice,seizures,shock and coma may be noted.noted.n nBulging fontanel may be found,but there is not meningeal Bulging fontanel may be found,but there is not meningeal irritation sign.irritati

37、on sign.第二十六页，讲稿共四十六页哦Complication n nSubdural effusionSubdural effusionn nSubdural effusions occur in about 10%-30%of children with Subdural effusions occur in about 10%-30%of children with bacterial meningitis.bacterial meningitis.n nSubdural effusions appear to be more frequent in the children Su

38、bdural effusions appear to be more frequent in the children under the age of 1 year and inunder the age of 1 year and in haemophilus influenzae and haemophilus influenzae and pneumococal infection.pneumococal infection.n nClinical manifestations are enlargement in head Clinical manifestations are en

39、largement in head circumference,bulging fontanel,circumference,bulging fontanel,cranial sutures diastasis and abnormal transillumination of the skull.and abnormal transillumination of the skull.n nSubdural effusions may be diagnosed by the examination of Subdural effusions may be diagnosed by the ex

40、amination of CT or MRI and subdural pricking.CT or MRI and subdural pricking.第二十七页，讲稿共四十六页哦Complicationn nEpendymitis n nNeonate or infant with meningitis n nGram-negative bacterial infection n nClinical manifestation n nPersistent hyperpyrexia,Persistent hyperpyrexia,n nFrequent convulsion Frequent

41、 convulsion n nAcute respiratory failure Acute respiratory failure n nBulging fontanel Bulging fontanel n nVentriculomegaly(CT)Ventriculomegaly(CT)n nCerebrospinal fluidCerebrospinal fluid by ventricular punctureby ventricular puncturen nWBC5010WBC50109 9/L/Ln nGlucose1.6mmol/LGlucoseo.4g/LProteino.

42、4g/L第二十八页，讲稿共四十六页哦Complicationn nCerebullar hyponatremian nSyndrem of inappropriate secretion of antidiuretic hormone(SIADH)n nHyponatremia Hyponatremia n nDegrade of blood osmotic pressureDegrade of blood osmotic pressuren nAggravatedAggravated cerebral edema cerebral edeman nFrequent convulsion n

43、nAggravatedAggravated c conscious disturbance 第二十九页，讲稿共四十六页哦Complicationn nHydrocephalus Hydrocephalus n nIncreased intracranial pressureIncreased intracranial pressuren nBulging fontanelBulging fontaneln nAugmentation of head circumferenceAugmentation of head circumferencen nBrain function disorder

44、 Brain function disorder n nOther complicationn nDeafness or blindnessDeafness or blindnessn nEpilepsyEpilepsyn nParalysis Paralysis n nMental retardationMental retardationn nBehavior disorderBehavior disorder 第三十页，讲稿共四十六页哦Laboratory Findingsn nPeripheral hemogramn nTotal WBC count n n20109/L 40109/

45、L WBCn nDecreased WBC count at severe infectionn nLeukocyte differential countn n80%90%Neutrophils第三十一页，讲稿共四十六页哦Laboratory Findingsn nRout Rout e examination of cerebrospinal fluid(CSF)xamination of cerebrospinal fluid(CSF)n nIncreased pressure of cerebrospinal fluid Increased pressure of cerebrospi

46、nal fluid n nCloudinessCloudiness n nEvident Increased total WBC count(100010Evident Increased total WBC count(1000109 9/L)/L)n nEvident Increased neutrophils in leukocyte differential countEvident Increased neutrophils in leukocyte differential countn nEvident Decreased glucose(1.1mmol/l)Evident De

47、creased glucose(1.1mmol/l)n nEvident Increased protein levelEvident Increased protein level n nDecreased or normal chloridateDecreased or normal chloridaten nCSF film preparation or cultivation:positive result CSF film preparation or cultivation:positive result 第三十二页，讲稿共四十六页哦Laboratory Findingsn nEs

48、pecial examination of CSFn nSpecific bacterial antigen testn nCountercurrent immuno-electrophoresisCountercurrent immuno-electrophoresisn nLatex agglutinationLatex agglutinationn nImmunofluorescent testImmunofluorescent test n nNeisseria meningitidis(meningococcus)Neisseria meningitidis(meningococcu

49、s)n nHaemophilus influenzae Haemophilus influenzae n nStreptococcus pneumoniae(pneumococcus)Streptococcus pneumoniae(pneumococcus)n nGroup B streptococcusGroup B streptococcus第三十三页，讲稿共四十六页哦Laboratory Findingsn nEspecial examination of CSFn nOther test of CSFn nLDHLDHn nLactic acidLactic acidn nCRPn

50、nTNF and Ign nNeuron specific enolase(NSE)第三十四页，讲稿共四十六页哦Laboratory Findingsn nOther bacterial testn nBlood cultivationn nFilm preparation of skin petechiae and purpuran nSecretion culture of local lesion n nImageology examination第三十五页，讲稿共四十六页哦Diagnosisn nDiagnostic methodsn nA careful evaluation of