化脓性脑膜炎专题教育培训课件.ppt

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1、化脓性脑膜炎专题教育,化脓性脑膜炎专题教育,Purpose and demand:,To familiarize the pathogeny of purulent meningitis.To understand the mechanism and pathology change.To grasp the clinical manifestation,diagnosis,differential diagnosis and treatment.To self-study the accessory examination of neural system.,化脓性脑膜炎专题教育,2,Pur

2、pose and demand:To familiar,Contents,InductionEtiology & pathogenesisManifestationsComplicationsLaboratory findingsDiagnosis & differential diagnosisTreatment & prevention,化脓性脑膜炎专题教育,3,ContentsInduction化脓性脑膜炎专题教育3,Introduction,Acute infection of central nervous system(CNS). 75% of cases occur in the

3、 age of 2yr. The inflammation of meninges caused by various bacteria.Common features in clinical practices include: fever,headache,vomit, convulsions, disturbance of consciousness,increased intracranial pressure, meningeal irritation. One of the most potentially serious infections, associated with h

4、igh mortality (about 10%) and morbidity.,化脓性脑膜炎专题教育,4,Introduction Acute infection o,Etiology,1. Pathogens:Main pathogens: Neissria meningitidis, streptoccus pneumoniae, Haemophilus influenzae.2/3 of purulent meningitis are caused by these pathogens,化脓性脑膜炎专题教育,5,Etiology1. Pathogens:化脓性脑膜炎专题教,1. Pat

5、hogens(Pathogens in special populations )neonate & 3mo infants : Escherichia coli Streptococcus haemolyticus group B Staphlococcus aureus3mo infants : Haemophilus influenzae group B Streptococcus pneumoniae Neisseria meningitidis5yr children : Neisseria meningitidis Streptococcus pneumoniae,Etiology

6、,化脓性脑膜炎专题教育,6,1. Pathogens(Pathogens in spec,Etiology,2. Major risk factors for meningitisImmature immunologic function and attenuated immunologic response to pathogens Low level of immunoglobulin, defects of complement Immature or impaired blood-brain-barrier (BBB) Immature BBB function: maturation

7、 at about 1yr Impaired BBB: Congenial or acquired defects across mucocutaneous barrier,化脓性脑膜炎专题教育,7,Etiology2. Major risk factors,Access of bacteria invasion,Typical access-hematogenous dissemination Bacteria colonizing the mucous membranes of the nasopharynx invasion into local tissue bacteremia th

8、rough BBS mainly effect on arachnoid and leptomeninges Mode of transmission: Person to person contact through respiratory tract secretions or droplets,化脓性脑膜炎专题教育,8,Access of bacteria invasionTyp,Access of bacteria invasion,Invasion from parameningeal organs:such as paranasal sinuses or middle earBac

9、teria spread to the meninges directly: through anatomic defects in the skull or head trauma,化脓性脑膜炎专题教育,9,Access of bacteria invasionInv,Structure of meninges,化脓性脑膜炎专题教育,10,Structure of meninges 化脓性脑膜炎专,Pathology,Characterized by leptomeningeal and perivascular infiltration with polymorphonuclear leu

10、kocytes 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.,化脓性脑膜炎专题教育,11,PathologyCharacterized by lept,Clinical manifestations,Prodrome:acute onset,precede by

11、 several days of upper respiratory infections or gastrointestinal symptoms fulminant onset:epidemic cerebrospinal meningitis manifestations:progressing shock bleeding spots in the skin or ecchymosis disseminated intravascular coagulation disturbance of central nervous system.,化脓性脑膜炎专题教育,12,Clinical

12、manifestationsProdrom,Clinical manifestations,Common features of meningitis: signs of systemic infection : fever,headache,fatigue,weakness,anorexia,bleeding spots in the skin,ecchymosis, alteration of mental status and consciousness,化脓性脑膜炎专题教育,13,Clinical manifestationsCommon,Clinical manifestations

13、,Common features of meningitis: neurological signs: meningeal irritation: nuchal rigidity,kernig sign, brudzinski sign increased intracranial pressure: headache, vomiting, herniation Seizure (20-30%) Focal or generalized Due to cerebritis, infarction, electrolyte disturbances Frequently noted with H

14、 influenzae & S pneumococcal meningitis,化脓性脑膜炎专题教育,14,Clinical manifestationsCommon,When flexing the hip 90 degrees and then extending the leg, the patient feels subsequent pain,化脓性脑膜炎专题教育,15,When flexing the hip 90 degree,When passively flexing the neck while supine, patient involuntarily flexes hi

15、s knees and hips.,化脓性脑膜炎专题教育,16,When passively flexing the nec,Clinical manifestations,Common features of meningitis: neurological signs: alteration of mental status and consciousnessincluding:irritability,lethargy,somnolence,confusion,stuppor,comadue to increased intracranial pressure,cerebritis fo

16、cal signs、 cranial nerves in trouble,paralysis,sensory disturbance,mainly caused by vascular occlusion,化脓性脑膜炎专题教育,17,Clinical manifestationsCommon,Clinical manifestations,The symptoms and signs are not evident in neonates and infants younger than 3mo of age; and patients already received irregular a

17、ntibiotic therapy.,化脓性脑膜炎专题教育,18,Clinical manifestations,Comparison of the manifestations of meningitis between different age groups,化脓性脑膜炎专题教育,19,Comparison of the manifestatio,Complications and sequelae,Subdural effusionDefinitive diagnosis: volume of fluid in subdural space 2ml, protein0.4g/L, In

18、cidence: 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); Causative organisms: H influenzae, S pneumoniae,化脓性脑膜炎专题教育,20,Complications and sequelaeSubd,Complications and sequelae,Indications: No response to

19、a sensitive antibiotic therapy Prolonged fever or fever reoccurring after an afebrile interval with effective treatment Bulging fontanel, widening of sutures, enlarging head circumference, vomit,seizure, altered consciousness. Improved CSF profile with more serious clinical manifestations,化脓性脑膜炎专题教育

20、,21,Complications and sequelaeIndi,Complications and sequelae,Diagnosis methods: Cranial translucent test B ultrasonic examination and CT Subdural space puncture,normal,subdural effusion,化脓性脑膜炎专题教育,22,Complications and sequelae Dia,Complications and sequelae,2. VentriculitisUsually occurs in neonate

21、s and infants (50 x106/L, Glucose400mg/L.,化脓性脑膜炎专题教育,23,Complications and sequelae2. V,Complications and sequelae,3. hydrocephalus :Communicating hydrocephalusincreasing neuropsychiatric symptoms4.Cerebral hyponatremia:The syndrome of inappropriate secretion of antidiuretic hormone5.others:Deafness,

22、 blindness, paralysis, epilepsy, mental retardation,化脓性脑膜炎专题教育,24,Complications and sequelae3. h,化脓性脑膜炎专题教育培训课件,Examinations,2.Cerebrospinal fluid examinations:(2)special examination:Specific bacterial antigen-detection test Countercurrent immuno-electrophoresis,CIE Latex agglutination Immunofluores

23、cent testLDH,lactic acid,CRP,TNF,Ig,NSE determinations,化脓性脑膜炎专题教育,26,Examinations2.Cerebrospinal fl,Examinations,3.Other examinations(1)blood culture:before antibiotic therapy(2)petechia smear:epidemic cerebrospinal meningitis(3)other secretion cultures:(4)imaging:CT&MRI,化脓性脑膜炎专题教育,27,Examinations3.

24、Other examinatio,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 irritation, increased intracranial pressure, altered mental status Pay attention t

25、o the atypical symptoms and signs in neonate, infant and patient already received irregular antibiotic therapy,化脓性脑膜炎专题教育,28,DiagnosisEarlier diagnosis and,Diagnosis,Diagnosis is confirmed by analysis of cerebrospinal fluid ( CSF) Suggestion bacterial meningitis Increased pressure (90%) Appearance:

26、slightly cloudy to purulent Raised white blood cells,consisting chiefly of polymorphonuclear leukocytes Raised protein concentration, Decreased glucose concentration (80%),化脓性脑膜炎专题教育,29,DiagnosisDiagnosis is confirme,Diagnosis, Confirmation of the diagnosis: isolation from the CSF of a specific bact

27、erial 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.definitive diagnosis, determination of antibiotic sensitivity. PCR: amplifies bacterial

28、DNA (H influenzae, N. meningitidis),化脓性脑膜炎专题教育,30,Diagnosis Confirmation of t,Differential diagnosis,Viral meningitis/encephalitis: Less severe systemic infectious symptoms Usually not develop after 2-3weeks CSF: normal glucoseTuberculous meningitis: Subacute onset and progress A history of close co

29、ntact with known cases of tuberculosis Evidence of acute or healed tubercular infection on chest x-ray Tuberculin skin test : OT, PPD CSF,化脓性脑膜炎专题教育,31,Differential diagnosisViral me,Differential diagnosis,Cryptococcal meningitis:slow onset,a long course of disease,increased intracranial pressuresev

30、ere headacheCSF changes:similar with tuberculous meningitisconfirmed by Indiainkstaining or culture of CSFMollarets meningitis:etiology:unknowclinical manifestations and CSF:recurrent,similar to purulent meningitisCSF:Mollarets cellsadrenocortical hormone therapy:effective,化脓性脑膜炎专题教育,32,Differential

31、 diagnosisCryptoco,Differential diagnosis,Brain abscess:slow onsetCSF:pressure ,cellnormal or ,protein further diagnosis:CT or MRIAcute toxic encephalopathy:manifestations:delirium,convulsions,coma,meningeal irritation,cerebral palsyCSF:only pressure ,化脓性脑膜炎专题教育,33,Differential diagnosisBrain ab,化脓性

32、脑膜炎专题教育,34,压力kpa外观潘氏试验白细胞数（106/L）蛋白质糖（mm,Treatment,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,化脓性脑膜炎专题教育,35,Treatment1.Antibacterial th

33、era,Treatment,at the time of unknown pathogenic bacteria: First choice: Cefotaxime, Ceftriaxone (3dr generation of cephalosporins, high permeability through BBB, products of metabolism also has effect, CSF sterilization within 24h) Other choice: Penicillin, Chloramphenicol, ( side effects: gray baby

34、 syndrome and bone marrow suppression)at the time of known pathogenic bacteria: refer to drug sensitivity test,化脓性脑膜炎专题教育,36,Treatmentat the time of unknow,Antibiotic therapy of bacterial meningitis,化脓性脑膜炎专题教育,37,Antibiotic therapy of bacteria,Treatment,2.Adrenal cortical hormone: dexamethasone:0.3-

35、0.5mg/kg/day3.Symptomatic treatment & supportive care Increased intracranial pressure: Intravenous mannitol 0.5-1g/kg/every time,q4-6hConvulsions:diazepam & chloral hydrate & phenobarbitalFever:Acetaminophen & ibuprofen Maintenance fluid and thermal energy supplement: fluid administration:60-80ml/kg

36、/day fluid infusion with dehydration therapy,化脓性脑膜炎专题教育,38,Treatment2.Adrenal cortical ho,Treatment,4.Treatment of complicationsSubdural effusion Few volume could be absorbed with treatment spontaneously Subdural puncture: take out 20-30ml/each time (unilateral puncture), less than 50-60ml/each time ( bilateral puncture), everyday or every other dayVentriculitis : lateral ventricle puncture and injection of antibiotics locally Cerebral hyponatremia:supplement of sodium,化脓性脑膜炎专题教育,39,Treatment4.Treatment of compli,