兒科英文課件化膿性腦膜炎第一頁，共四十六頁，2022年，8月28日IntroductionBacterialmeningitisisaninflammationoftheleptomenings,usuallycausingbybacterialinfection.Bacterialmeningitismaypresentacutely(symptomsevolvingrapidlyover1-24hours),subacutely(symptomsevolvingover1-7days),orchronically(symptomsevolvingovermorethan1week).第二頁，共四十六頁，2022年，8月28日IntroductionAnnualincidenceinthedevelopedcountriesisapproximately5-10per100000.30000infantsandchildrendevelopbacterialmeningitisinUnitedStateseachyear.Approximately90percentofcasesoccurinchildrenduringthefirst5yearsoflife.第三頁，共四十六頁，2022年，8月28日IntroductionCasesunderage2yearsaccountforalmost75%ofallcasesandincidenceisthehighestinearlychildhoodatage6-12monthsthaninanyotherperiodoflife.Therearesignificantdifferenceintheincidenceofbacterialmeningitisbyseason.

第四頁，共四十六頁，2022年，8月28日EtiologyCausativeorganismsvarywithpatientage,withthreebacteriaaccountingforoverthree-quartersofallcases:Neisseriameningitidis(meningococcus)Haemophilusinfluenzae(ifveryyoungandunvaccinated)Streptococcuspneumoniae(pneumococcus)第五頁，共四十六頁，2022年，8月28日EtiologyOtherorganismsNeonatesandinfantsatage2-3monthsEscherichiacoliB-haemolyticstreptococciStaphylococcusaureusStaphylococcusepidermidisListeriamonocytogenes第六頁，共四十六頁，2022年，8月28日EtiologyElderlyandimmunocompromisedListeriamonocytogenesGramnegativebacteriaHospital-acquiredinfectionsKlebsiellaEscherichiacoliPseudomonasStaphylococcusaureus第七頁，共四十六頁，2022年，8月28日EtiologyThemostcommonorganismsNeonatesandinfantsundertheageof2monthsEscherichiacoliPseudomonasGroupBStreptococcusStaphylococcusaureus

第八頁，共四十六頁，2022年，8月28日EtiologyChildrenover2monthsHaemophilusinfluenzaetypebNeisseriameningitidisStreptococcuspneumoniaeChildrenover12yearsNeisseriameningitidisStreptococcuspneumoniae第九頁，共四十六頁，2022年，8月28日EtiologyMajorroutesofleptomeninginfectionBacteriaaremainlyfromblood.Uncommonly,meningitisoccursbydirectextensionfromnearlyfocus(mastoiditis,sinusitis)orbydirectinvasion(dermoidsinustract,headtrauma,meningo-myelocele).第十頁，共四十六頁，2022年，8月28日PathogenesisSusceptibilityofbacterialinfectiononCNSinthechildren

ImmaturityofimmunesystemsNonspecificimmuneInsufficientbarrier(Blood-brainbarrier)InsufficientcomplementactivityInsufficientchemotaxisofneutrophilsInsufficientfunctionofmonocyte-macrophagesystemBloodlevelsofdiminishedinterferon(INF)-γandinterleukin-8(IL-8)第十一頁，共四十六頁，2022年，8月28日PathogenesisSusceptibilityofbacterialinfectiononCNSinthechildrenSpecificimmuneImmaturityofboththecellularandhumoralimmunesystemsInsufficientantibody-mediatedprotectionDiminishedimmunologicresponseBacterialvirulence第十二頁，共四十六頁，2022年，8月28日PathogenesisAoffendingbacteriumfrombloodinvadestheleptomeninges.BacterialtoxicsandInflammatorymediatorsarereleased.BacterialtoxicsLipopolysaccharide,LPSTeichoicacidPeptidoglycanInflammatorymediatorsTumornecrosisfactor,TNFInterleukin-1,IL-1ProstaglandinE2,PGE2第十三頁，共四十六頁，2022年，8月28日PathogenesisBacterialtoxicsandinflammatorymediatorscausesuppurativeinflammation.InflammatoryinfiltrationVascularpermeabilityalterTissueedemaBlood-brainbarrier

detroyThrombosis第十四頁，共四十六頁，2022年，8月28日PathologyDiffusebacterialinfectionsinvolvetheleptomeninges,arachnoidmembraneandsuperficialcorticalstructures,andbrainparenchymaisalsoinflamed.Meningealexudateofvaryingthicknessisfound.Thereispurulentmaterialaroundveinsandvenoussinuses,overtheconvexityofthebrain,inthedepthsofthesulci,withinthebasalcisterns,andaroundthecerebellum,andspinalcordmaybeencasedinpus.

Ventriculitis(purulentmaterialwithintheventricles)hasbeenobservedrepeatedlyinchildrenwhohavediedoftheirdisease.第十五頁，共四十六頁，2022年，8月28日PathologyInvasionoftheventricularwallwithperivascularcollectionsofpurulentmaterial,lossofependymallining,andsubependymalgliosismay

benoted.Subduralempyemamayoccur.Hydrocephalusisancommoncomplicationofmeningitis.ObstructivehydrocephalusCommunicatinghydrocephalus

第十六頁，共四十六頁，2022年，8月28日PathologyBloodvesselwallsmayinfiltratedbyinflammatorycells.EndothelialcellinjuryVesselstenosisSecondaryischemiaandinfarctionVentricledilatation

whichensuesmaybeassociatedwithnecrosisofcerebraltissueduetotheinflammatoryprocessitselfortoocclusionofcerebralveinsorarteries.第十七頁，共四十六頁，2022年，8月28日PathologyInflammatoryprocessmayresultincerebraledemaanddamageofthecerebralcortex.ConsciousdisturbanceConvulsionMotordisturbanceSensorydisturbance

Meningealirritationsignisfound

becausethespinalnerverootisirritated.Cranialnervemaybedamaged第十八頁，共四十六頁，2022年，8月28日ClinicalmanifestationBacterialmeningitismaypresentacutely(symptomsevolvingrapidlyover1-24hours)inmostcases.Symptomsandsignsofupperrespiratoryorgastrointestinalinfectionarefoundbeforeseveraldayswhentheclnicalmanifestationsofbacterialmeningitishappen.SomepatientsmayaccesssuddenlywithshockandDIC.第十九頁，共四十六頁，2022年，8月28日ClinicalmanifestationToxicsymptomalloverthebody

HyperpyrexiaHeadachePhotophobiaPainfuleyemovementFatiguedandweakMalaise,myalgia,anorexia,Vomiting,diarrheaandabdominalpainCutaneousrashPetechiae,purpura

第二十頁，共四十六頁，2022年，8月28日ClinicalmanifestationClinicalmanifestationofCNSIncreasedintracranialpressureHeadacheProjectilevomitingHypertensionBradycardiaBulgingfontanelCranialsuturesdiastasisComaDecerebraterigidityCerebralhernia

第二十一頁，共四十六頁，2022年，8月28日ClinicalmanifestationClinicalmanifestationofCNSSeizuresSeizuresoccurinabout20%-30%ofchildrenwithbacterialmeningitis.Seizuresisoftenfoundinhaemophilusinfluenzaeandpneumococalinfection.Seizuresiscorrelativewiththeinflammationofbrainparenchyma,cerbralinfarctionandelectrolytedisturbances.

第一課件網(wǎng)站

第二十二頁，共四十六頁，2022年，8月28日ClinicalmanifestationClinicalmanifestationofCNSConsciousdisturbanceDrowsinessCloudingofconsciousnessComaPsychiatric

symptom

IrritationDysphoriadullness

第二十三頁，共四十六頁，2022年，8月28日ClinicalmanifestationClinicalmanifestationofCNSMeningealirritationsignNeckstiffnessPositiveKernig’ssignPositiveBrudzinski’ssign第二十四頁，共四十六頁，2022年，8月28日ClinicalmanifestationClinicalmanifestationofCNSTransientorpermanentparalysisofcranialnervesandlimbsmaybenoted.Deafnessordisturbancesinvestibularfunctionarerelativelycommon.Involvementoftheopticnerve,withblindness,israre.Paralysisofthe6thcranialnerve,usuallytransient,isnotedfrequentlyearlyinthecourse.第二十五頁，共四十六頁，2022年，8月28日ClinicalmanifestationSymptomandsignsoftheinfantundertheageof3monthsInsomechildren,particularlyyounginfantsundertheageof3months,symptomandsignsofmeningealinflammationmaybeminimal.Feverisgenerallypresent,butitsabsenceorhypothermia

inainfantwithmeningealinflammationiscommon.Onlyirritability,restlessness,dullness,vomiting,poorfeeding,cyanosis,dyspnea,jaundice,seizures,shockandcomamaybenoted.Bulgingfontanelmaybefound,butthereisnotmeningealirritationsign.第二十六頁，共四十六頁，2022年，8月28日Complication

SubduraleffusionSubduraleffusionsoccurinabout10%-30%ofchildrenwithbacterialmeningitis.Subduraleffusionsappeartobemorefrequentinthechildrenundertheageof1yearandin

haemophilusinfluenzaeandpneumococalinfection.Clinicalmanifestationsareenlargementinheadcircumference,bulgingfontanel,cranialsuturesdiastasisandabnormaltransilluminationoftheskull.SubduraleffusionsmaybediagnosedbytheexaminationofCTorMRIandsubduralpricking.

第二十七頁，共四十六頁，2022年，8月28日ComplicationEpendymitis

NeonateorinfantwithmeningitisGram-negativebacterialinfectionClinicalmanifestation

Persistenthyperpyrexia,FrequentconvulsionAcuterespiratoryfailureBulgingfontanelVentriculomegaly(CT)Cerebrospinalfluid

byventricularpunctureWBC>50×109/LGlucose<1.6mmol/LProtein>o.4g/L第二十八頁，共四十六頁，2022年，8月28日ComplicationCerebullarhyponatremiaSyndremofinappropriatesecretionofantidiuretichormone(SIADH)HyponatremiaDegradeofbloodosmoticpressureAggravated

cerebraledemaFrequentconvulsionAggravatedconsciousdisturbance

第二十九頁，共四十六頁，2022年，8月28日ComplicationHydrocephalusIncreasedintracranialpressureBulgingfontanelAugmentationofheadcircumferenceBrainfunctiondisorderOthercomplicationDeafnessorblindnessEpilepsyParalysisMentalretardationBehaviordisorder

第三十頁，共四十六頁，2022年，8月28日LaboratoryFindingsPeripheralhemogramTotalWBCcount

20×109/L～40×109/LWBCDecreasedWBCcountatsevereinfectionLeukocytedifferentialcount80%～90%Neutrophils第三十一頁，共四十六頁，2022年，8月28日LaboratoryFindingsRoutexaminationofcerebrospinalfluid(CSF)IncreasedpressureofcerebrospinalfluidCloudiness

EvidentIncreasedtotalWBCcount(>1000×109/L)EvidentIncreasedneutrophilsinleukocytedifferentialcountEvidentDecreasedglucose(<1.1mmol/l)

EvidentIncreasedproteinlevel

DecreasedornormalchloridateCSFfilmpreparationorcultivation:positiveresult第三十二頁，共四十六頁，2022年，8月28日LaboratoryFindingsEspecialexaminationofCSFSpecificbacterialantigentestCountercurrentimmuno-electrophoresisLatexagglutinationImmunofluorescenttest

Neisseriameningitidis(meningococcus)HaemophilusinfluenzaeStreptococcuspneumoniae(pneumococcus)GroupBstreptococcus第三十三頁，共四十六頁，2022年，8月28日LaboratoryFindingsEspecialexaminationofCSFOthertestofCSFLDHLacticacidCRPTNFandIgNeuronspecificenolase(NSE)第三十四頁，共四十六頁，2022年，8月28日LaboratoryFindingsOtherbacterialtestBloodcultivationFilmpreparationofskinpetechiaeandpurpuraSecretioncultureoflocallesionImageologyexamination第三十五頁，共四十六頁，2022年，8月28日DiagnosisDiagnosticmethodsAcarefulevaluationofhistoryAcarefulevaluationofinfant’ssignsandsymptomsAcarefulevaluationofinformationonlongitudinalchangesinvitalsignsandlaboratoryindicatorsRoutexaminationofcerebrospinalfluid(CSF)第三十六頁，共四十六頁，2022年，8月28日DifferentialdiagnosisClinicalmanifestationofbacterialmeningitisissimilartoclinicalmanifestationofviral,tuberculous,fungalandasepticmeningitis.Differentiationofthesedisordersdependsuponcarefulexaminationofcerebrospinalfluidobtainedbylumbarpunctureandadditionalimmunologic,roentgenographic,andisotopestudies.第三十七頁，共四十六頁，2022年，8月28日Characteristics

ofCSFoncommondiseaseinCNS

PMTMVWFMTEPressure↑↑－or↑↑↑↑Cloudiness＋＋or＋＋＋＋－±－PandyT＋＋or＋＋＋＋or＋＋＋±or＋＋＋or＋＋＋－WBC↑↑↑N↑L－or↑L↑M－Protein↑↑↑↑↑↑－or↑↑↑－or±Glucos↓↓↓↓↓－↓↓－Chloridate－or↓↓↓↓－↓↓－CultivationBacteriumTBViralFungus－第三十八頁，共四十六頁，2022年，8月28日Treatment

AntibioticTherapyTherapeuticprincipleGoodpermeabilityforBlood-brainbarrierDrugcombinationIntravenousdripFulldosageFullcourseoftreatment

第三十九頁，共四十六頁，2022年，8月28日AntibioticTherapySelectionofantibioticNoCertainlyBacteriumCommunity-acquiredbacterialinfectionNosocomialinfectionacquiredinahospitalBroad-spectrumantibioticcoverageasnotedbelowChildrenunderage3monthsCefotaximeandampicillinCeftriaxoneandampicillin(childrenoverage1months)Childrenover3monthsCefotaximeorCeftriaxoneorampicillinandchloramphenicol第四十頁，共四十六頁，2022年，8月28日AntibioticTherapyCertainlyBacteriumOncethepathogenhasbeenidentifiedandtheantibioticsensitivitiesdetermined,themostappropriatedrugs

shouldselected.Nmeningitidis:penicillin,

tert-

cephalosporin

Spneumoniae:penicillin,

tert-

cephalosporin,vancomycin

Hinfluenzae:ampicillin,

tert-

cephalosporin

Saureus:penicillin,

nefcillin,vancomycin

Ecoli:ampicillin,

chloramphenicol,tert-

cephalosporin

第四十一頁，共四十六頁，2022年，8月28日AntibioticTherapyCourseoftreatment7daysformeningococcalinfection10～14daysforHinfluenzaeorSpn