流行性腦脊髓膜炎epidemiccerebrospinalmeningitis

1、 流行性腦脊髓膜炎 epidemic cerebrospinal meningitis1概述病原學 腦膜炎奈瑟菌 內(nèi)毒素是其重要的致病因素 可產(chǎn)生自溶酶 分13群：A B C D 29E H I K W135 X Y Z2流腦病人腦脊液革蘭染色可見成雙排列的革蘭陰性雙球菌。3流行病學（一）傳染源：病人 帶菌者（二）傳播途徑：呼吸道飛沫（三）人群易感性：兒童發(fā)病率高（四）流行特征：冬春季多發(fā) 周期性流行4發(fā)病機制隱性感染帶菌者菌血癥皮膚淤點敗血癥發(fā)熱等腦脊髓膜化膿性炎癥細菌 鼻咽部5敗血癥期細菌皮膚粘膜血管內(nèi)皮細胞內(nèi)繁殖引起出血壞死（淤點 淤斑）釋放內(nèi)毒素大量內(nèi)毒素全身小血管痙攣微循環(huán)障礙有效循

2、環(huán)血量減少（感染性休克）血流緩慢血細胞凝聚 加上血管內(nèi)皮細胞損傷 組織損傷激活凝血系統(tǒng)DIC加重微循環(huán)障礙出血 MOF6腦膜炎期腦膜脊髓膜血管內(nèi)皮細胞壞死 血管通透性增加血漿外滲 水腫 重者腦實質(zhì)亦有炎癥內(nèi)毒素腦微循環(huán)障礙缺氧 水腫 出血昏迷 抽搐 腦疝78臨床表現(xiàn)（一）普通型 1、前驅(qū)期（上呼吸道感染期） 2、敗血癥期 3、腦膜炎期 4、恢復期91011（二）暴發(fā)型 1、休克型 fulminant meningococcal septicemia acute respiratory distress syndrome 2、腦膜腦炎型 3、混合型（三）輕型（四）慢性腦膜炎雙球菌敗血癥12實驗室

3、檢查（一）血象 WBC升高 （1020）109/L（二）CSF（三）細菌學檢查 1、凃片 2、培養(yǎng)（四）免疫學檢查 特異性抗原、抗體 13診斷1、流行病學資料2、臨床表現(xiàn)3、實驗室檢查14 肺炎鏈球菌 streptococcus pneumoniae 流感嗜血桿菌 haemophilus influenzae 金黃色葡萄球菌 staphylococcus aureus（2）結(jié)核性腦膜炎（3）流行性乙型腦炎2、其他病原菌引起的敗血癥休克鑒別診斷1、其他病原體引起的中樞神經(jīng)系統(tǒng)感染（1）其他細菌引起的化膿性腦膜炎15治療（一）普通型的治療 1、一般治療 2、病原治療 青霉素G 首選 磺胺嘧啶 氯霉

4、素 三代頭孢菌素 3、對癥治療 16（二）暴發(fā)型的治療 1、休克型的治療 抗菌藥 糾正休克 腎上腺皮質(zhì)激素 DIC治療 保護重要臟器功能 2、腦膜腦炎型的治療 抗菌藥 防治腦水腫、腦疝、呼吸衰竭 腎上腺皮質(zhì)激素17預防（一）管理傳染源（二）切斷傳播途徑（三）提高人群免疫力 A群多糖菌苗 雙價菌苗 四價菌苗18Meningococcal InfectionsMeningococcal infections are a major cause of mortality and morbidity in developed and developing nations. Neisseria meni

5、ngitidis is the causative agent in meningococcal infections. It has become the most common cause of bacterial meningitis in American children since the use of the Haemophilus influenzae type b protein-capsular polysaccharide conjugate vaccine in infants dramatically reduced their incidence of mening

6、itis due to this organism. Considerable progress has been made in the management and prevention of infections due to Neisseria meningitidis since the organism was first described in 1887. Because the meningococcal vaccine has limited effectiveness in the group at greatest risk to infection, 19childr

7、en younger than the age of 2, meningococcal infection is still a major worldwide problem. The devastating nature of systemic meningococcal infection makes it imperative that preventive measures be developed to fully control this disease. In addition, an effective vaccine against meningococcal serogroup B infection has not been developed. Until this goal is realized, it is crucial that the clinician recognize and be able to successfull