儿科PM(英文班).ppt

Purulent　  Meningitis What is purulent meningitis? Definition : Inflammation of leptomeninges which is caused by a variety of bacteria. Typical clinical manifestations: a. fever b. convulsion, disturbance of consciousness c. signs of intracranial hypertension (vomting, headache, etc) d. meningeal irritation sign e. cerebral spinal fluid (CSF) changes Pathogens of PM Infants within 3 months: Enteric bacilli (Escherichia coli) Staphylococcus ; Streptococcus Salmonella Children between 3 months and 3 years : Pneumococcus ; Hemophilus influenzae Meningococcus Children over 4 year old: Pneumococcus ; Staphylococcus Hemophilus influenzae Escherichia coli Meningococcus Pneumococcus 肺炎链球菌性疾病(pneumococal diseases，PDs) PDs已成为全球一个重要的公共卫生问题。肺炎链球菌(Streptococcus pneumoniae)始终是导致婴幼儿脑膜炎、菌血症、肺炎等严重疾病的首位病原菌，也是引起鼻窦炎和急性中耳炎(AOM)的最常见病因[1]。根据WHO2005年的估计，全球每年有160万人死于PDs，5岁以下儿童有70万～100万人，其中多数生活在发展中国家。在亚太地区，每小时约有49名儿童死于肺炎链球菌性肺炎。全球5岁以下儿童，通过疫苗可预防死亡的病因中肺炎链球菌占到28%，排名首位。 ——儿童肺炎链球菌性疾病防治技术指南(2009年版) 肺炎链球菌可引起非侵袭性疾病，主要包括扁桃体咽炎、中耳炎、鼻窦炎和非菌血症性肺炎等，也可以引起严重的侵袭性疾病。所谓侵袭性疾病是指肺炎链球菌侵入与外环境无直接相通的、原本无菌的部位和组织引致感染，包括脑膜炎、菌血症、脓毒症、菌血症性肺炎以及脓胸、心包炎、心内膜炎、腹膜炎和化脓性骨关节炎等 。 Hemophilus influenzae Infective routes Hematogenous dissemination (the most common) Spread from adjacent region Direct spread Predisposing Factors Host defense and blood brain barrier are not well developed Special immune function states blood system diseases Pathology of PM Hyperemia of meninges Polymorphonuclear cells infiltrate into parenchyma and perivascular tissue of the brain. Meningeal exudates distribute around brain surface, cranial base, spinal cord. Ventriculitis and inflammatory cells in CSF are present. Cerebral cortical necroses and vascular occlusion occur. Typical clinical manifestations Signs of intracranial hypertension : Headache Vomitin