化脓性脑膜炎的鉴别诊断和治疗

• 常见细菌：脑膜炎双球菌、肺炎链球菌、流感 嗜血杆菌。
Causative Organisms in Episodes(Nonrecurrent) of Bacterial Meningitis in Adults at aTertiary Care Hospital, 1962 to 1989
Organism Srtreptococcus pneumoniae Gram-negtive bacilli Neisseria meningitis Streptococci Listeria monocytogenes Staphylococcus aureus Community Acquired(%)(n=253) 38 4 14 7 11 5 Nosocomial(%) (n=151) 5 38 1 9 3 9
Incidence and Mortality Rate for Central Nervous Infection from 1950 to 1981,in Olmsted County,Minnesota
Infection Aseptic meningitis Bacterial meningitis Viral encephalitis Brain abscess Chronic meningitis
Agents of Gram-Negative Bacillary Meningitis in Adults
CASES OGANISM Escherichia coli Klabsiella ssp Pseudomonas spp Enterobacter spp Serratia spp Acinetobacterr spp Salmonella spp N 84 73 35 26 19 15 8 % 30 26 12 9 7 5 3
Incidence (per 100,000 person- Mortality years) (%) 10.9 0 8.6 7.4 1.1 0.4 10 3.8 37 43
细菌性脑膜炎
• 细菌性脑膜炎（化脓性脑膜炎）：是由化脓性 细菌所引起的软脑膜与蛛网膜的化脓性感染， 及其在蛛网膜下腔和脑室系统的扩散。临床表 现为：发热、头痛及脑膜刺激症状较重并伴毒 血症状，起病及，病情进展快，如不及时治疗， 可危及生命，或残留一定的后遗症。
化脓性脑膜炎的鉴别诊断和治疗
脑膜炎
是指病原体下腔和脑室系统的扩散。
•脑膜炎
•一、按病因分（常见） •1细菌性 2病毒性 3结核性 4真菌性 •二、按病程分 •急性：病程不超过4周，如一些化脓性脑膜炎 （流脑），病毒性脑膜炎。 •慢性：脑膜刺激症状和体征持续超过4周伴脑 脊液WBC升高。常见结核性，真菌性脑膜炎。
Relationship of Bacterial Meningitis Pathogens
Pathogen Haemophilus influenzae Neisseria meningitis Streptociccus pneumoniae Escherichia coli Other gram-negative bacilli Group B streptococi Other streptococci Listeria monocytogenes Staphlococcus.A and staphylococcus.E Miscellaneous <2Month 2 0.5 2 38 11.5 22 6 6 3.5 8 99.5 1 2.5 100 4 .05 2.5 10 100 2Month-15Years(%) 59 24 13 0.5 <0.2 4 >16Years 4 29 46
流行性脑脊髓膜炎
流行性脑脊髓膜炎（流脑）是由脑膜炎球菌引 起的化脓性脑膜炎。主要表现为突起高热、头 痛、呕吐、皮肤黏膜淤点及脑膜刺激征。
Causative Organisms in Episodes(Nonrecurrent) of Bacterial Meningitis in Adults at aTertiary Care Hospital, 1962 to 1989
Organism Coauglase-negative staphylococci Mixed bacterial species Haemophilus influenzae Enterococci Other Culture-negative Community Acquired (%)(n=253) 0 2 4 0 2 13 Nosocomial (%)(n=151) 9 7 4 3 3 11
Pathogens of Bacterial Meningitis in the United States, 1978 Through 1981
CASE ORGANISM Haemophlilus influenzae Neisseria meningitis Streptococcus pneumoniae GroupB streptococi Listeria monocytogenes Other Unknouwn Total N 6,756 2,742 1,863 476 265 1,043 827 13,974 99.9 % 48.3 19.6 13.3 3.4 1.9 7.5 5.9 CASEFATALITY RATE(%) 6 10.3 26.3 22.5 28.5 33.7 16.4
Agents of Gram-Negative Bacillary Meningitis in Adults
CASES OGANISM Proteus spp Pasteurella multocida Citrobacter spp Aeromonas spp Flavobacterium spp Mixed Total 6 284 2 100 2 N 9 3 % 3 1 1 1