神经病课件05脑炎forSMU1703知识介绍.pptVIP

* * * Encephalitis Hospitalization Rates and Inpatient Mortality in the United States, 2000-2010 NOS = not otherwise specified * * Initial management on suspicion of acute viral encephalitis * If the first-line diagnostics turn out to be negative, a second lumbar puncture is compulsory to rule out false-negative herpes simplex virus (HSV) and VZV PCR analyses . In the absence of clinical improvement, furtherinvestigation is needed * Diagnostic performance of a multiplex PCR assay for meningitis in an HIV-infected population in Uganda BioMérieux收购的BioFire快速脑膜炎和脑炎测试通过了FDA的审核， 2015年10月8日,美国食品和药品监管局(FDA)允许为同时检测脑脊液(CSF)中可致中枢神经系统感染的多个病原体的第一个基于核酸测试上市。 FilmArray ME Panel被设计同时地测试对14种细菌，病毒和酵母病原体利用一个小CSF样品和可在约一小时内提供结果，它可能使医生更早做告知的治疗决定。当前，对 多个有机体CSF测试并不总是可能的因为可能很难从每个患者得到足够液体进行多个测试。利用当前方法中枢神经系统感染致病细菌的鉴定可能有时花费三天。 类似的有测结核的机器：Xpert MTB/RIF?检测试剂盒为美国Cepheid公司开发的， * Epidemiology of viral encephalitis in 2011 Médecine et maladies infectieuses 41 (2011) 453–464 * * * Epidemiology of viral encephalitis in 2011 Médecine et maladies infectieuses 41 (2011) 453–464 * * Pathways for entry of HSV to the brain include both the olfactory and the trigeminal nerves and hematogenous spread. * Theoretically, the mechanism of HSV entry into the brain could be because of: 1. reactivation of the viral genome in the trigeminal ganglion, a natural reservoir of HSV-1 latent infection ,with resultant axonal spread via the trigeminal nerve into the frontal andtemporal lobes 2. in-situ reactivation of the latent virus from central nervous system (CNS) tissue, where it can occasionally be identified 3. primary infection of the nervous system. HSV II型多引起脑膜炎 * Hemorrhage and Cowdry type A inclusions bodies are found readily in the margins of areas of necrosis. * 病毒性脑炎的诊断 再次腰穿及进一步的检查 对脑炎患者的微生物病原学诊断评估项目 病毒性脑炎的诊断 辅助检查的敏感性: 取样时机和检测方法 Multiplex PCR assay Diagn Microbiol Infect Dis. 2016 Mar:268-73 常见的病毒性脑炎1 Virus (Family) Viral Structure Transmission Mortality Rate SpecificClinical Patterns Sequelae Se