化脓性脑膜炎英文版培训课件.ppt
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1、化脓性脑膜炎英文版化脓性脑膜炎英文版 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 potentially serio
2、us infections,associated with high mortality(about 10%)and morbidity.Purulent Meningitis化脓性脑膜炎英文版21.Etiology2.1.1 Pathogens:Main pathogens:Neissria meningitidis,streptoccus pneumoniae,Haemophilus influenzae.(2/3 of purulent meningitis are caused by these pathogens)Pathogens in special populations(ne
3、onate&3mo infants,malnutrition,immunodeficiency):gramnegative enteric bacilli,group B streptococci,staphlococcus aureus 化脓性脑膜炎英文版31.2 Major risk factors for meningitis Immature immunologic function and attenuated immunologic response to pathogens Low level of immunoglobulin,defects of complement and
4、 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 化脓性脑膜炎英文版4 1.3 Access of bacteria invasion Typical access-hematogenous dissemination Bacteria colonizing the mucous mem
5、branes 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化脓性脑膜炎英文版5 Bacteria spread to the meninges directly:through anatomic defects in the skull or he
6、ad trauma Invasion from parameningeal organs:such as paranasal sinuses or middle earAccess of bacteria invasion化脓性脑膜炎英文版62.Pathology Structure of meninges 化脓性脑膜炎英文版7 Characterized by leptomeningeal and perivascular infiltration with polymorphonuclear leukocytes and an inflammatory exudate.Exudate wh
7、ich may be distributed from convexity of brain to basal region of cranium.Exudate is more thickness due to streptococcus pneumoniae than other pathogens.Pathology化脓性脑膜炎英文版83.Clinical manifestations The younger the child is,the higher incidence of meningitis will be.-2/3 of cases occur less than 1yr
8、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).化脓性脑膜炎英文版9 Subacute onset:Precede by several days of upper respiratory tract or gastroin
9、testinal 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 presentation化脓性脑膜炎英文版10 Common features of meningitis:signs of systemic infection:fever(90-95%),anorexia,sho
10、ck,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化脓性脑膜炎英文版11brudzinski sign化脓性脑膜炎英文版12 Seizure(20-30%)Focal or generalized
11、 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化脓性脑膜炎英文版13 Clinical manifestations Alteration of mental status and consciousness Including:irrit
12、ability,lethargy,stupor obtundation,coma Due to increased intracranial pressure,cerebritis,hypotension Often with pneumococcal or meningococcal meningitis Comatose patients with a poor prognosis化脓性脑膜炎英文版14 The symptoms and signs are not evident in neonates and infants younger than 3mo of age;and pat
13、ients already received irregular antibiotic therapy.Clinical manifestations化脓性脑膜炎英文版15Signs of systemic infectionIncreased intracranial pressuremeningeal irritationTypical(older children)Fever,altered consciousness,seizureHeadache,vomiting,herniationnuchal rigidity,back pain,kernig sign,brudzinski s
14、ignAtypical(neonate&3mo infant)Fever,normal temperature or hypothermia;minim or subtle seizure;poor feeding;less activityScream,frown;bulging or full fontanel;widening of the suturesNot evidentComparison of the manifestations of meningitis between different age groupsClinical manifestations化脓性脑膜炎英文版
15、164.Diagnosis Earlier diagnosis and prompt initiation of effective antibiotic treatment is critical 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 s
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