,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Purulent Meningitis,Purpose and demand:,To familiarize the pathogeny of purulent meningitis.,To understand the mechanism and pathology change.,To grasp the clinical manifestation,diagnosis,differential diagnosis and treatment.,To self-study the accessory examination of neural system.,Contents,Induction,Etiology&pathogenesis,Manifestations,Complications,Laboratory findings,Diagnosis&differential diagnosis,Treatment&prevention,Introduction,Acute infection of central nervous system(CNS).75%of cases occur in the age of 2yr.,The inflammation of meninges caused by various bacteria.Common features in clinical practices include:fever,headache,vomit,convulsions,disturbance of consciousness,increased intracranial pressure,meningeal irritation.,One of the most potentially serious infections,associated with high mortality(about 10%)and morbidity.,Etiology,1.Pathogens:,Main pathogens,:Neissria meningitidis,streptoccus pneumoniae,Haemophilus influenzae.,2/3 of purulent meningitis are caused by these pathogens,1.Pathogens(,Pathogens in special populations,),neonate&,3mo infants:Escherichia coli,Streptococcus haemolyticus group B,Staphlococcus aureus,3mo infants:Haemophilus influenzae group B,Streptococcus pneumoniae,Neisseria meningitidis,5yr children:,Neisseria meningitidis,Streptococcus pneumoniae,Etiology,Etiology,2.Major risk factors for meningitis,Immature immunologic function and attenuated,immunologic response to pathogens,Low level of immunoglobulin,defects of complement,Immature or impaired blood-brain-barrier(BBB),Immature BBB function:maturation at about 1yr,Impaired BBB:Congenial or acquired defects,across mucocutaneous barrier,Access of bacteria invasion,Typical access-,-hematogenous dissemination,Bacteria colonizing the mucous membranes of,the nasopharynx,invasion into local tissue,bacteremia through BBS mainly effect on arachnoid and leptomeninges,Mode of transmission:Person to person contact,through respiratory tract secretions or droplets,Access of bacteria invasion,Invasion from parameningeal organs:such as paranasal sinuses or middle ear,Bacteria spread to the meninges directly:through anatomic defects in the skull or head trauma,Structure of meninges,Pathology,Characterized by leptomeningeal and perivascular infiltration with polymorphonuclear leukocytes and an inflammatory exudate.,Exudate which may be distributed from convexity of brain to basal region of cranium.,Exudate is more thickness due to streptococcus pneumoniae than other pathogens.,Clinical manifestations,Prodrome:,acute onset,precede by several days of upper respiratory infections or gastrointestinal symptoms,fulminant onset:epidemic cerebrospinal meningitis,manifestations:progressing shock,bleeding spots in the skin or ecchymosis,disseminated intravascular coagulation,disturbance of central nervous system.,Clinical manifestations,Common features of meningitis:,signs of systemic infection,:,fever,headache,fatigue,weakness,anorexia,bleeding spots in the skin,ecchymosis,alteration of mental status and consciousness,Clinical manifestations,Common features of meningitis:,neurological signs:,meningeal irritation,:nuchal rigidity,kernig sign,brudzinski sign,increased intracranial pressure,:headache,vomiting,herniation,Seizure(20-30%),Focal or generalized,Due to cerebritis,infarction,electrolyte disturbances,Frequently noted with H influenzae&S pneumococcal meningitis,When flexing the hip 90 degrees and then extending the leg,the patient feels subsequent pain,When passively flexing the neck while supine,patient involuntarily flexes his knees and hips.,Clinical manifestations,Common features of meningitis:,neurological signs:,alteration of mental status and consciousness,including:irritability,lethargy,somnolence,confusion,stuppor,coma,due to increased intracranial pressure,cerebritis,focal signs,、,、,、,、,、,cranial nerves in trouble,paralysis,sensory disturbance,mainly caused by vascular occlusion,Clinical manifestations,The symptoms and signs are not evident in neonates and infants younger than 3mo of age;and patients already received irregular antibiotic therapy.,Comparison of the manifestations of meningitis between different age groups,Signs of systemic infection,Increased intracranial pressure,meningeal irritation,Typical,(older children),Fever,altered consciousness,seizure,Headache,vomiting,herniation,nuchal rigidity,back pain,kernig sign,brudzinski sign,Atypical,(neonate&2ml,protein0.4g/L,Incidence:develop in 10-30%of patients,asymptomatic in 85-90%of patients;especially common in infants 4-6 month of age(rare in children over 1yr);,Causative organisms:H influenzae,S pneumoniae,Complications and sequelae,Indications:,No response to a sensitive antibiotic therapy,Prolonged fever or fever reoccurring after an,afebrile interval with effective treatment,Bulging fontanel,widening of sutures,enlarging head circumference,vomit,seizure,altered consciousness.,Improved CSF profile with more serious clinica