感染病学（上海交通大学）流行性脑脊髓膜炎课件.pptVIP

meningococcal meningitis Clinical Manifestation Fulminant Type Meningo-encephalitis 脑实质损害 脑疝 枕骨大孔疝:又称小脑扁桃体疝.幕下的小脑扁桃体及延髓经枕骨大孔被挤向椎管内以延髓急性损害症状为主,生命体征改变. 天幕裂孔疝:又称小脑幕切迹疝.幕上的脑组织(颞叶的海马回、钩回)通过小脑幕切迹被挤向幕下.初起时病侧瞳孔略缩小，光反应稍迟钝，以后病侧瞳孔逐渐散大，略不规则，直接及间接光反应消失，健侧肢体瘫痪。 Mixed type meningococcal meningitis meningococcal meningitis Clinical Manifestation Mild Type fever, joint pain and symptoms of an upper respiratory infection. Less rash Children and Old man meningococcal meningitis Lab Blood routine WBC↑↑↑，NE↑↑ CSF 混浊，WBC1000X106/L，多核为主 Pr↑, Glu↓ Cl-↓ 颅压↑ meningococcal meningitis LUMBER PUNCTURE meningococcal meningitis Lab Bacteriology 涂片 meningococcal meningitis Lab Bacteriology 培养 meningococcal meningitis Lab Immunology Antigene Antibody Others CSF-β2-microglobulin CST-LDH meningococcal meningitis Complications and persisting sequelae Diagnosis and different diagnosis Diagnosis 季节，突发高热，头痛，呕吐 瘀斑，脑膜刺激症 血、脑脊液检查，细菌培养 Different diagnosis 其他细菌 病毒脑，结脑，霉脑 败血症休克型 meningococcal meningitis meningococcal meningitis Treatment 普通型 一般治疗 病原治疗:大剂量青霉素，三代头孢，SMZco. 氯霉素考试用 对症治疗 暴发型 休克型：纠正休克 脑膜脑炎型：减轻脑水肿，防脑疝 meningococcal meningitis Prevention 传染源 传播途径 易感人群 菌苗注射 SMZco Meningococcal Meningitis 流行性脑脊髓膜炎 meningococcal meningitis Introduction 亚撒哈拉非洲被称为 Meningitis Belt. 不论是发达国家，还是发展中国家， 80% 的细菌性脑膜炎由3种致病菌引起: Haemophilus influenzae type B (Hib), Streptococcus pneumoniae and Neisseria meningitidis meningococcal meningitis Introduction meningitidis, the causative organism of meningococcal meningitis, was first isolated from cerebrospinal fluid and described in 1887 by Weichselbaum meningococcal meningitis Introduction 感染涉及： 脑膜炎、菌血症、呼吸道、关节、心包、眼、 泌尿生殖系等 主要临床表现： Fever Headache Vomiting Neck stiffness A diffuse maculopapular rash Joint pain Photophobia meningococcal meningitis Bacteria The Neisseria family is made up of more than 10 species. Only 2 of them are of clinical importance N. gonorrhoeae, responsible for gonorrhea, N. meningitidis, responsible for meningoc