,单击此处编辑母版标题样式,无忧,PPT,整理发布,单击此处编辑母版标题样式,Purulent Meningitis,Purulent Meningitis,Acute infection of central nervous system(CNS).90%of cases occur in the age of 1mo-5yr.,The inflammation of meninges caused by various bacteria.Common features in clinical practices include:fever,increased intracranial pressure,meningeal irritation.,One of the most potentially serious infections,associated with high mortality(about 10%)and morbidity.,Acute infection of central ne,Pathogens:,Main pathogens,:,Neisseria meningitidis,Streptococcus pneumoniae,Haemophilus influenzae.(2/3 of purulent meningitis are caused by these pathogens),Pathogens in special populations,(neonates&3mo infants,malnutrition,immunodeficiency),:gramnegative enteric bacilli,group B streptococci,staphlococcus aureus,1.Etiology,Pathogens:1.Etiology,2.Pathology,Structure of meninges,2.Pathology,Characterized by leptomeningeal and,perivascular infiltration with,polymorphonuclear leukocytes and,inflammatory exudate.,Exudate which may be distributed,from convexity of brain to basal,region of cranium.,Pathology,Characterized by leptomeninge,The younger the child is,the higher incidence of,meningitis will be.1/2-2/3 of cases occur less than,1yr of age.,Mode of presentation:,Acute or fulminant onset,:,symptoms and signs of sepsis;meningitis evolve rapidly over a few hours and death within 24 hours;usually infected with Neisseria meningitidis(N.meningitidis).,Subacute onset,:,Precede by several days of upper respiratory tract or gastrointestinal symptoms;difficult to,pinpoint the exact onset of meningitis;usually with meningitis due to Haemophilus influenzae (H influenzae)and streptococcus pneumococcus(S pneumococcus).,3.Clinical manifestations,3.Clinical manifestations,Common features of meningitis:,signs of systemic infection,:fever(90-95%),anorexia,shock,alteration of mental status,and consciousness,neurological signs:,increased intracranial pressure,:headache,vomiting(82%),herniation,meningeal irritation,:nuchal rigidity(77%),kernig sign,brudzinski sign,Clinical manifestations,Common features of meningitis,A positive Brudzinskis sign(flexion of the hips and knees in response to passive flexion of the neck)signals meningeal irritation.Passive flexion of the neck stretches the nerve roots,causing pain and involuntary flexion of the knees and hips.,Kernigs sign elicits resistance and,hamstring muscle pain when the,examiner attempts to extend the knee while the hip and knee are flexed 90 degrees,A positive Brudzinskis sign(,Seizure(20-30%),Focal or generalized,Due to cerebritis,infarction,electrolyte,disturbances,Frequently noted with Haemophilus,influenzae&Streptococcus,pneumococcal meningitis,Clinical manifestations,Seizure(20-30%)Clinical m,Clinical manifestations,Alteration of mental status and consciousness,Including:irritability,lethargy,stupor and,coma,Due to increased intracranial pressure,cerebritis,hypotension,Often with pneumococcal or meningococcal,meningitis,Clinical manifestations A,The symptoms and signs are not evident in,neonates or infants younger than 3mo of,age or patients already received irregular,antibiotic therapy.,Clinical manifestations,The symptoms and signs are no,Earlier diagnosis and prompt initiation of effective,antibiotic treatment is critical for minimizing sequelae,of purulent meningitis.,Suspected cases:febrile infants with seizure,meningeal irritability,increased intracranial pressure,altered mental status,Pay attention to the atypical symptoms and signs in,neonates,infants and patients already received,antibiotic therapy,4.Diagnosis,4.Diagnosis,Diagnosis is confirmed by analysis of,cerebrospinal fluid,(CSF),Diagnosis,Lumber puncture,Diagnosis is confirmed by anal,Diagnosis,Suggestion bacterial meningitis,Increased pressure(90%),Appearance:slightly cloudy to purulent,Raised white blood cells,consisting chiefly,of polymorphonuclear leukocytes,Raised protein concentration,decreased,glucose concentration(80%),analysis of,cerebrospinal fluid,(CSF),Diagnosis Suggestion bacter,Viral meningitis:,Less severe,systemic infectious symptoms,Usually not develop after 2-3weeks,CSF:normal glucose,5.Differential diagnosis,Viral meningitis:5.Diff,Tuberculous meningitis,Subacute onset and progress,A history of close contact with known cases,of tuberculosis,Evidence of acute or healed tubercular,infection on chest x-ray,Tuberculin skin test:PPD,CSF,Differential diagnosis,Tuberculous meningitisDiffe,Disease,Pressure,(Kpa),aspect,Total WBC,(x10,6,/L),Protein,(g/L),Glucose,(mmol/L),smears,cultures,normal,0.69-1.96,(0.29-0.78),clear,0-5,(0-20),0.2-0.4,(0.2-1.2),2.2-4.4,-,-,Purulent,meningitis,cloudy,(PMN),(1-5),(2.2),Grams stain+,+,Tuberculous,meningitis,Normal or cloudy,(MN),AFB stain+,Viral meningitis/,encephalitis,Normal or,Normal,Normal or,(MN),Normal or,(2ml,protein0.4g/L,6.Complications,6.1 Subdural effusion6.Compli,Indications:,No response to a sensitive antibiotic therapy,Prolonged fever or fever reoccurring after an,afebrile interval with eff