治疗其他化脓性脑膜炎预后.pptVIP

* In adults, HSV-2 is spread by venereal transmission and causes aseptic meningitis. The ability of HSV-1 to induce apoptosis (programmed cell death, or “cellular suicide”) in neuronal cells, a property not shared by HSV-2 RNA viruses usually replicate within the cytoplasm of infected cells, whereas DNA viruses replicate in the nucleus. most arboviruses are more likely to produce encephalitis than meningitis, whereas most enteroviruses produce far more cases of meningitis than encephalitis * Electroencephalography (EEG), though lacking in specificity (32%), has 84% sensitivity to abnormal patterns in HSE. * About 50% of the population has antibody to HSV-1 by age 15 years, whereas 50% to 90% of adults have antibody, depending on socioeconomic status. HSV-1 encephalitis may occur at any age, but more than 50% of cases occur in patients older than 20 years of age. PCR is highly sensitive (94-98%) and specific (98-100%). Results become positive within 24 hours of the onset of symptoms and remain positive for at least 5-7 days after the start of antiviral therapy. * Without treatment, the disease is fatal in about 70% to 80% of patients, and patients who survive the acute disease are usually left with severe neurologic residuals acyclovir reduced mortality to 28% Outcome depends on patient age, level of consciousness, and the rapidity with which treatment is instituted. Untreated HSE is progressive and often fatal in 7-14 days. Patients who are comatose at diagnosis have a poor prognosis regardless of their age. In noncomatose patients, the prognosis is age related, with better outcomes occurring in patients younger than 30 years. * M-metabolic代谢、I-Infection传染、D-Degenerative退化、N-Neoplasm肿瘤、I-Inflammation炎症、G-gland、H-Hereditary、T-Traumatoxin 结核性脑膜炎发病率—0.35-0.7/10万/年 结核性脑膜炎 病因和发病机制 病原菌 人型结核分枝杆菌 牛型结核分枝杆菌 感染途径 血行播散 淋巴系统播散 局部播散 结核性脑膜炎 病理 脑底部渗出物 血管炎 脑积水 结核性脑膜炎 临床表现 慢性、亚急性、急性 脑膜炎共有症状 颅高压 脑膜刺激征 结核菌相对有特点的症状 毒血症状：低热、盗汗、纳差、乏力、精神软 脑神经损害 脑实质损害 结核性脑膜炎 辅助检查 金标准：抗酸染色，结核菌培养