儿科英文化脓性脑膜炎Bacterialmeningitis.ppt
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1、儿科英文化脓性脑膜炎BacterialmeningitisIntroductionn nAnnual incidence in the developed countries is approximately 5-10 per 100000.n n30000 infants and children develop bacterial meningitis in United States each year.n nApproximately 90 per cent of cases occur in children during the first 5 years of life.Intr
2、oductionn nCases under age 2 years account for almost 75%of all cases and incidence is the highest in early childhood at age 6-12 months than in any other period of life.n nThere are significant difference in the incidence of bacterial meningitis by season.Etiologyn nCausative organisms vary with pa
3、tient age,with three bacteria accounting for over three-quarters of all cases:n nNeisseria meningitidis(meningococcus)Neisseria meningitidis(meningococcus)n nHaemophilus influenzae(if very young and Haemophilus influenzae(if very young and unvaccinated)unvaccinated)n nStreptococcus pneumoniae(pneumo
4、coccus)Streptococcus pneumoniae(pneumococcus)Etiologyn nOther organisms n nNeonates and infants at age 2-3 months n nEscherichia coliEscherichia colin nB-haemolytic streptococciB-haemolytic streptococcin nStaphylococcus aureusStaphylococcus aureusn nStaphylococcusStaphylococcus epidermidisn nListeri
5、a monocytogenesListeria monocytogenesEtiologyn nElderly and immunocompromisedElderly and immunocompromisedn nListeria monocytogenesListeria monocytogenesn nGram negative bacteriaGram negative bacterian nHospital-acquired infectionsHospital-acquired infectionsn nKlebsiellaKlebsiellan nEscherichia col
6、iEscherichia colin nPseudomonasPseudomonasn nStaphylococcus aureusStaphylococcus aureusEtiologyn nThe most common organisms n nNeonates and infants under the age of 2monthsNeonates and infants under the age of 2monthsn nEscherichia coli Escherichia coli n nPseudomonas Pseudomonas n nGroup B Streptoc
7、occusGroup B Streptococcusn nStaphylococcus aureusStaphylococcus aureus Etiologyn nChildren over 2 monthsn nHaemophilus influenzae type bHaemophilus influenzae type bn nNeisseria meningitidisNeisseria meningitidisn nStreptococcus pneumoniaeStreptococcus pneumoniaen nChildren over 12 yearsn nNeisseri
8、a meningitidisNeisseria meningitidisn nStreptococcus pneumoniaeStreptococcus pneumoniaeEtiologyn nMajor routes of leptomening infectionn nBacteria are mainly from blood.Bacteria are mainly from blood.n nUncommonly,meningitis occurs by direct Uncommonly,meningitis occurs by direct extension from near
9、ly focus(mastoiditis,extension from nearly focus(mastoiditis,sinusitis)or by direct invasion(dermoid sinus sinusitis)or by direct invasion(dermoid sinus tract,head trauma,meningo-myelocele).tract,head trauma,meningo-myelocele).Pathogenesisn nSusceptibility of bacterial infection on CNS in the childr
10、en n nImmaturity of immune systemsn nNonspecific immuneNonspecific immunen nInsufficient barrierInsufficient barrier(Blood-brain barrierBlood-brain barrier)n nInsufficient complement activityInsufficient complement activityn nInsufficient chemotaxis of neutrophilsInsufficient chemotaxis of neutrophi
11、lsn nInsufficient function of monocyte-macrophage systemInsufficient function of monocyte-macrophage systemn nBlood levels of diminished interferon(INF)-and Blood levels of diminished interferon(INF)-and interleukin-8(IL-8)interleukin-8(IL-8)Pathogenesisn nSusceptibility of bacterial infection on CN
12、S in the childrenn nSpecific immuneSpecific immunen nImmaturity of both the cellular and humoral immune Immaturity of both the cellular and humoral immune systemssystemsn nInsufficient antibody-mediated protectionInsufficient antibody-mediated protectionn nDiminished immunologic responseDiminished i
13、mmunologic responsen nBacterial virulence Bacterial virulence Pathogenesisn nA offending bacterium from blood invades the A offending bacterium from blood invades the leptomeninges.leptomeninges.n nBacterial toxics and Inflammatory mediators are Bacterial toxics and Inflammatory mediators are releas
14、ed.released.n nBacterial toxicsBacterial toxicsn nLipopolysaccharide,LPSLipopolysaccharide,LPSn nTeichoic acidTeichoic acidn nPeptidoglycan Peptidoglycan n nInflammatory mediatorsInflammatory mediatorsn nTumor necrosis factor,TNFTumor necrosis factor,TNFn nInterleukin-1,IL-1Interleukin-1,IL-1n nPros
15、taglandin E2,PGE2Prostaglandin E2,PGE2Pathogenesisn nBacterial toxics and inflammatory mediators cause suppurative inflammation.n nInflammatory infiltrationInflammatory infiltrationn nVascular permeability alterVascular permeability altern nTissue edema Tissue edema n nBlood-brain barrierBlood-brain
16、 barrier detroydetroyn nThrombosis Thrombosis Pathologyn nDiffuse bacterial infections involve the leptomeninges,Diffuse bacterial infections involve the leptomeninges,arachnoid membrane and superficial cortical arachnoid membrane and superficial cortical structures,and brain parenchyma is also infl
17、amed.structures,and brain parenchyma is also inflamed.n nMeningeal exudate of varying thickness is found.Meningeal exudate of varying thickness is found.n nThere is purulent material around veins and venous There is purulent material around veins and venous sinuses,over the convexity of the brain,in
18、 the depths of sinuses,over the convexity of the brain,in the depths of the sulci,within the basal cisterns,and around the the sulci,within the basal cisterns,and around the cerebellum,and spinal cord may be encased in pus.cerebellum,and spinal cord may be encased in pus.n nVentriculitis(purulent ma
19、terial within the ventricles)Ventriculitis(purulent material within the ventricles)has been observed repeatedly in children who have has been observed repeatedly in children who have died of their disease.died of their disease.Pathologyn nInvasion of the ventricular wall with perivascular Invasion o
20、f the ventricular wall with perivascular collections of purulent material,loss of ependymal collections of purulent material,loss of ependymal lining,and subependymal gliosis maylining,and subependymal gliosis may be noted.be noted.n nSubdural empyema may occur.Subdural empyema may occur.n nHydrocep
21、halus is an common complication of Hydrocephalus is an common complication of meningitis.meningitis.n nObstructive hydrocephalus Obstructive hydrocephalus n nCommunicating hydrocephalusCommunicating hydrocephalus Pathologyn nBlood vessel walls may infiltrated by inflammatory cells.Blood vessel walls
22、 may infiltrated by inflammatory cells.n nEndothelial cell injuryEndothelial cell injuryn nVessel stenosisVessel stenosisn nSecondary ischemia and infarctionSecondary ischemia and infarctionn nVentricle dilatationVentricle dilatation which ensues may be associated with which ensues may be associated
23、 with necrosis of cerebral tissue due to the inflammatory necrosis of cerebral tissue due to the inflammatory process itself or to occlusion of cerebral veins or arteries.process itself or to occlusion of cerebral veins or arteries.Pathologyn nInflammatory process may result in cerebral Inflammatory
24、 process may result in cerebral edema and damage of the cerebral cortex.edema and damage of the cerebral cortex.n nConscious disturbanceConscious disturbancen nConvulsionConvulsionn nMotor disturbance Motor disturbance n nSensory disturbanceSensory disturbance n nMeningeal irritation sign is foundMe
25、ningeal irritation sign is found because the because the spinal nerve root is irritated.spinal nerve root is irritated.n nCranial nerve may be damagedCranial nerve may be damagedClinical manifestationn nBacterial meningitis may present acutely(symptoms Bacterial meningitis may present acutely(sympto
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