化脓性脑膜炎英文PPT讲稿.ppt

《化脓性脑膜炎英文PPT讲稿.ppt》由会员分享，可在线阅读，更多相关《化脓性脑膜炎英文PPT讲稿.ppt（42页珍藏版）》请在淘文阁 - 分享文档赚钱的网站上搜索。

1、化脓性脑膜炎英文第1页，共42页，编辑于2022年，星期五 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 potent

2、ially serious infections,associated with high mortality(about 10%)and morbidity.Purulent Meningitis第2页，共42页，编辑于2022年，星期五1.Etiology1.1 Pathogens:Main pathogens:Neissria meningitidis,streptoccus pneumoniae,Haemophilus influenzae.(2/3 of purulent meningitis are caused by these pathogens)Pathogens in sp

3、ecial populations(neonate&3mo infants,malnutrition,immunodeficiency):gramnegative enteric bacilli,group B streptococci,staphlococcus aureus 第3页，共42页，编辑于2022年，星期五1.2 Major risk factors for meningitis Immature immunologic function and attenuated immunologic response to pathogens Low level of immunoglo

4、bulin,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 第4页，共42页，编辑于2022年，星期五 1.3 Access of bacteria invasion Typical access-hematogenous dissem

5、ination 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 droplets第5页，共42页，编辑于2022年，星期五 Bacteria spread to the meninges

6、 directly:through anatomic defects in the skull or head trauma Invasion from parameningeal organs:such as paranasal sinuses or middle earAccess of bacteria invasion第6页，共42页，编辑于2022年，星期五2.Pathology Structure of meninges 第7页，共42页，编辑于2022年，星期五 Characterized by leptomeningeal and perivascular infiltrati

7、on 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 streptococcus pneumoniae than other pathogens.Pathology第8页，共42页，编辑于2022年，星期五3.Clinical manifestations The younger the

8、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 sepsis;meningitis evolve rapidly over a few hours and death within 24 hours;usually infected with Neissria meningitides (N.meningitides).第9

9、页，共42页，编辑于2022年，星期五 Subacute onset:Precede by several days of upper respiratory tract or gastrointestinal symptoms;difficult to pinpoint the exact onset of meningitis;usually with meningitis due to Haemophilus influenzae (H influenzae)and streptoccus pneumococcus (S pneumococcus).Mode of presentatio

10、n第10页，共42页，编辑于2022年，星期五 Common features of meningitis:signs of systemic infection:fever(90-95%),anorexia,shock,alteration of mental status and consciousness neurological signs:increased intracranial pressure:headache,vomiting(82%),herniation meningeal irritation:nuchal rigidity(77%),kernig sign,brud

11、zinski sign Clinical manifestations第11页，共42页，编辑于2022年，星期五brudzinski sign第12页，共42页，编辑于2022年，星期五*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

12、 prognosisClinical manifestations第13页，共42页，编辑于2022年，星期五 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 Coma

13、tose patients with a poor prognosis第14页，共42页，编辑于2022年，星期五 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第15页，共42页，编辑于2022年，星期五Signs of systemic infectionIncreased intracranial p

14、ressuremeningeal 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,frown;bul

15、ging or full fontanel;widening of the suturesNot evidentComparison of the manifestations of meningitis between different age groupsClinical manifestations第16页，共42页，编辑于2022年，星期五4.Diagnosis Earlier diagnosis and prompt initiation of effective antibiotic treatment is critical for minimizing sequelae of

16、 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 第17页，共42页，编辑于2022年，星期五 Diagnosis

17、 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 concentration,decreased glucose concentration(80%)Diagnosis第18

18、页，共42页，编辑于2022年，星期五 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 causative organism in 70-90%of cases CSF culture:positive in about 80%of cases.d

19、efinitive diagnosis,determination of antibiotic sensitivity.PCR:amplifies bacterial DNA(H influenzae,N.meningitidis)Diagnosis第19页，共42页，编辑于2022年，星期五5.Differential diagnosis Purulent meningitis caused by different pathogens Neissria meningitidis:Occur in epidemics(type A,C),which is more common in spr

20、ing,or sporadic all the year (type B,C,Y)Sudden onset with various cutaneous signs (petechiae,purpura,or an erythematous macular rash)第20页，共42页，编辑于2022年，星期五 Streptococcus pneumoniae:Young infants(1yr)are most susceptible population Peak season:spring and winter Easier to have subdural effusion and h

21、ydrocephalus Easily have a protracted course and relapseDifferential diagnosis第21页，共42页，编辑于2022年，星期五 Haemophilus influenzae Occurs predominantly in infants 2mo to 2yr of age Many cases are in winter Higher incidence of subdural effusion Others pathogens:staphylococcus aureus,gramnegative enteric bac

22、illi Special susceptible population:neonate,3mo infants,malnutrition,immunodeficiency Severe infection,difficult to treatDifferential diagnosis第22页，共42页，编辑于2022年，星期五 Meningitis caused by other microorganisms Viral meningitis/encephalitisViral meningitis/encephalitis:Less severe Less severe systemic

23、infectious symptoms Usually not develop after 2-3weeks Usually not develop after 2-3weeks CSF:normal glucose Differential diagnosis第23页，共42页，编辑于2022年，星期五 Tuberculous meningitisTuberculous meningitis Subacute onset and progress Subacute onset and progress A history of close contact with known A histo

24、ry of close contact with known cases of tuberculosis cases of tuberculosis Evidence of acute or healed tubercular Evidence of acute or healed tubercular infection on chest x-ray Tuberculin skin test:OT,PPD Tuberculin skin test:OT,PPD CSF CSFDifferential diagnosis第24页，共42页，编辑于2022年，星期五DiseasePressure

25、(Kpa)aspectTotal WBC(x106/L)Protein(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

26、 or(2ml,protein0.4g/L,Incidence: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);第26页，共42页，编辑于2022年，星期五 Causative organisms:45%of cases of meningitis caused by H influenzae,30%by S pneumoniae,9%by N meningitidissu

27、bdural effusion第27页，共42页，编辑于2022年，星期五 Indications:No response to a sensitive antibiotic therapy Prolonged fever or fever reoccurring after an afebrile interval with effective treatment Bulging fontanel,widening of sutures,enlarging head circumference,emesis,seizure,altered consciousness.Improved CSF

28、 profile with more serious clinical manifestationssubdural effusion第28页，共42页，编辑于2022年，星期五 Diagnosis methods:Cranial translucent test B ultrasonic examination and CT Subdural space puncture subdural effusionnormalsubdural effusion第29页，共42页，编辑于2022年，星期五6.2 Ventriculitis6.3 hydrocephalusComplications第3

29、0页，共42页，编辑于2022年，星期五Circulation of cerebrospinal fluid(CSF)第31页，共42页，编辑于2022年，星期五6.2 Ventriculitis Usually occurs in neonates and infants(50 x106/L,Glucose400mg/L.or protein400mg/L.Ventriculitis第33页，共42页，编辑于2022年，星期五Circulation of cerebrospinal fluid(CSF)第34页，共42页，编辑于2022年，星期五6.3 hydrocephalus:Commu

30、nicating 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:Deafness,blindness,paralysis,epilepsy,mental retardationComplication

31、s第35页，共42页，编辑于2022年，星期五7.Treatment7.1 Antibacterial therapyTherapy principles:early treatment,antibiotics susceptible to pathogens and with high permeability through BBB,given intraveninously,enough dose,enough course of antibiotic therapy 第36页，共42页，编辑于2022年，星期五 Susceptible to pathogens First choice

32、:Cefotaxime,Ceftriaxone (3dr generation of cephalosporins,high permeability through BBB,products of metabolism also has effect,CSF sterilization within 24h)Other choice:Penicillin,Chloromycin,Cefuroxime,Ceftazidime(delayed effect to make CSF sterile,high incidence of relapse and deafness)Antibacteri

33、al therapy第37页，共42页，编辑于2022年，星期五EtiologyStandard antibiotics of choiceDuration of therapyH.influenzaeCefotaxime/Ceftriaxone7-10daysN.meningitidisCefotaxime/Ceftriaxone7daysS.pneumoniaeCefotaxime/Ceftriaxone2-3weeksStaphlococcus aureusSemisynthetic penicillins(Oxacillin sodium,Cloxacillin sodium),Nor

34、vancomycin3weeksE.coliCefotaxime/Ceftriaxone(or+ampicillin)3weeksUnknownCefotaxime/Ceftriaxone+ampicillin2-3weeksAntibiotic therapy of bacterial meningitis第38页，共42页，编辑于2022年，星期五 Maintenance fluid and thermal energy supplement:Fluid administration:60-80ml/kg/day Fluid infusion with dehydration therap

35、y7.2 Supportive care Treatment第39页，共42页，编辑于2022年，星期五 increased intracranial pressure Osmotic therapy:intravenous mannitol 0.5-1g/kg/every time,q4-6h Combination with intravenous dexamethasone:0.3-0.5mg/kg/day Endotracheal intubation and hyperventilation Treatment第40页，共42页，编辑于2022年，星期五 Subdural effus

36、ion Few volume could be absorbed with treatment spontaneously Subdural puncture:take out 15ml/each time (unilateral puncture),less than 30ml/each time (bilateral puncture),everyday or every other day Stripping operation:for the cases not cure after 3-4weeks Treatment第41页，共42页，编辑于2022年，星期五 Others:Ventriculitis:lateral ventricle puncture and injection of antibiotics locally Epilepsy:AEDsTreatment第42页，共42页，编辑于2022年，星期五