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1、化脓性脑膜炎purulentmeningitisAbbreviationsPMpurulentmeningitisCSFcerebrospinalfluidCNScentralnervoussystemICPintracranialpressureBBBblood-brainbarrierWBCwhitebloodcellNCneutrocyteINTRODUCTIONPurulentMeningitis(PM)isoneofseriousbacterialinfection.PMisassociatedwith
2、ahighrateofacutecomplicationsandriskofchronicsequelae.PMisquitecommonCNSdisordersinchildhood,anditshouldbeincludedinthedifferentialdiagnosisofalteredmentalstatus.概念由化脓性细菌引起的中枢神经系统急性感染性疾病病原学(1)常见病原脑膜炎球菌(meningococcus)肺炎球菌(pneumococcus)流感杆菌(haemophilusinfluenza
3、e)金黄色葡萄球菌（staphylococcusaureus）大肠杆菌（escherichiacoli）脑膜炎球菌肺炎球菌CommonbacteriaThefirst2month:escherichiacoli;staphylococcusaureus;2month~12yr:Pneumococcus;Meningococcus;Hemophilusinfluenzaetypeb.病原学(2)病原菌与年龄的关系新生儿大肠杆菌、绿脓杆菌、金黄色葡萄球菌儿童脑膜炎球菌、肺炎球菌、流感嗜血杆菌发病机制(1)Theris
4、kfactors1.Lackofimmunity:youngage,defectsofT-lymphocyte,defectsofimmunoglobulin,defectsofthecomplementsystemorproperdinsystem2.EnvironmentCongenitaloracquiredCSFleak:suchascranialdefectormiddleearfistulas,basalskullfracture,lumbosacraldermalsinus,penetratingc
5、ranialtraumaMeningoceleSinus[回顾]中枢神经系统脑膜的解剖及脑脊液的循环PATHOGENESISBacteriaattacktothemucosalepithelialcellreceptorsbypili,enterthecirculation,penetratetheBBB(blood-brainbarrier)totheCSF,colonizeandmultiply,theninciteinflammatoryresponseandpolymorphonuclearcellinf
6、iltration,whichproduceTNF,IL-1,PG-2andothercytokines.致病菌入侵途径致病菌软脑膜蛛网膜表层脑血流途径直接通道临近感染发病机制(2)决定入侵中枢神经系统的因素细菌数量毒力机体免疫状态多种细胞因子参与发病TNF，IL－1等PATHOLOGYMeningealexudationandvaryingthicknessVascularchanges:vasculitis,thrombosis,necrosisorocclusionofsmallvasculesCerebr
7、alinfarctionIncreasedICPVentriculitisHydrocephalus,communicatingDamageofthecerebralcortex轻症化脑的病理变化软脑膜及蛛网膜炎、表层脑组织为主的炎症反应，炎症渗出物主要在大脑顶部表面。重症化脑的病理变化除轻症的改变外，还出现血管病变、脑实质损害，脑室管膜炎、颅神经受累。CLINICAL MANIFESTATIONS(1)Nonspecificfinding:fever;anorexiaorpoorfeeding;symptoms
8、ofURI,myalgias,arthralgias,tachycardia,hypotension,variouscutaneoussigns(2)cerebraldysfunction:Seizures:focalorgeneralizedduetocerebritis,infarction,orelectrolytedisturbances.After4days,p
