化脓性脑膜炎(英文)医.pptVIP

; 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 serious infections, associated with high mortality (about 10%) and morbidity. ;Etiology 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 (neonate 3mo infants , malnutrition, immunodeficiency): gramnegative enteric bacilli, group B streptococci, staphlococcus aureus ;; 1.3 Access of bacteria invasion ? Typical access---hematogenous dissemination ? 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 ; Bacteria spread to the meninges directly: through anatomic defects in the skull or head trauma Invasion from parameningeal organs: such as paranasal sinuses or middle ear;2. Pathology Structure of meninges ; Characterized by leptomeningeal and perivascular infiltration 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.;3. Clinical manifestations The younger the 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 wi