新生儿学教学课件 化脑双语袁宝莉.pptVIP

化脓性脑膜炎purulent meningitis Abbreviations PM purulent meningitis CSF cerebrospinal fluid CNS central nervous system ICP intracranial pressure BBB blood-brain barrier WBC white blood cell NC neutrocyte INTRODUCTION Purulent Meningitis (PM) is one of serious bacterial infection. PM is associated with a high rate of acute complications and risk of chronic sequelae. PM is quite common CNS disorders in childhood, and it should be included in the differential diagnosis of altered mental status. 概念 由化脓性细菌引起的 中枢神经系统急性感 染性疾病 病原学(1) 常见病原 脑膜炎球菌 (meningococcus) 肺炎链球菌 (pneumococcus) 流感嗜血杆菌 (haemophilus influenzae) 金黄色葡萄球菌（staphylococcus aureus） 大肠杆菌（escherichia coli） Common bacteria The first 2 month: escherichia coli ; staphylococcus aureus; 2 month~12 yr: Pneumococcus; Meningococcus; Hemophilus influenzae type b. 病原学(2) 病原菌与年龄的关系 新生儿 大肠杆菌、绿脓杆菌、金黄色葡萄球菌 儿童 脑膜炎球菌、肺炎球菌、流感嗜血杆菌 发病机制(1) The risk factors 1. Lack of immunity: young age, defects of T-lymphocyte, defects of immunoglobulin, defects of the complement system or properdin system 2. Environment Congenital or acquired CSF leak: such as cranial defect or middle ear fistulas, basal skull fracture, lumbosacral dermal sinus, penetrating cranial trauma PATHOGENESIS Bacteria attack to the mucosal epithelial cell receptors by pili, enter the circulation, penetrate the BBB (blood-brain barrier) to the CSF, colonize and multiply, then incite inflammatory response and polymorphonuclear cell infiltration, which produce TNF, IL-1, PG-2 and other cytokines. 致病菌入侵途径 发病机制(2) 决定入侵中枢神经系统的因素 细菌数量 毒力 机体免疫状态 多种细胞因子参与发病 TNF，IL－1等 PATHOLOGY Meningeal exudation and varying thickness Vascular changes: vasculitis , thrombosis, necrosis or occlusion of small vascules Cerebral infarction Increased ICP Ventri