




已阅读5页,还剩34页未读, 继续免费阅读
版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
PurulentMeningitis,Purposeanddemand:,Tofamiliarizethepathogenyofpurulentmeningitis.Tounderstandthemechanismandpathologychange.Tograsptheclinicalmanifestation,diagnosis,differentialdiagnosisandtreatment.Toself-studytheaccessoryexaminationofneuralsystem.,Contents,InductionEtiologyandpatientsalreadyreceivedirregularantibiotictherapy.,Comparisonofthemanifestationsofmeningitisbetweendifferentagegroups,Complicationsandsequelae,SubduraleffusionDefinitivediagnosis:volumeoffluidinsubduralspace2ml,protein0.4g/L,Incidence:developin10-30%ofpatients,asymptomaticin85-90%ofpatients;especiallycommonininfants4-6monthofage(rareinchildrenover1yr);Causativeorganisms:Hinfluenzae,Spneumoniae,Complicationsandsequelae,Indications:NoresponsetoasensitiveantibiotictherapyProlongedfeverorfeverreoccurringafteranafebrileintervalwitheffectivetreatmentBulgingfontanel,wideningofsutures,enlargingheadcircumference,vomit,seizure,alteredconsciousness.ImprovedCSFprofilewithmoreseriousclinicalmanifestations,Complicationsandsequelae,Diagnosismethods:CranialtranslucenttestBultrasonicexaminationandCTSubduralspacepuncture,normal,subduraleffusion,Complicationsandsequelae,2.VentriculitisUsuallyoccursinneonatesandinfants(50 x106/L,Glucose400mg/L.,Complicationsandsequelae,3.hydrocephalus:Communicatinghydrocephalusincreasingneuropsychiatricsymptoms4.Cerebralhyponatremia:Thesyndromeofinappropriatesecretionofantidiuretichormone5.others:Deafness,blindness,paralysis,epilepsy,mentalretardation,Examinations,1.Bloodroutineexamination:WBCraisedproteinconcentration,1g/LFindingbacteriainCSF,Examinations,2.Cerebrospinalfluidexaminations:(2)specialexamination:Specificbacterialantigen-detectiontestCountercurrentimmuno-electrophoresis,CIELatexagglutinationImmunofluorescenttestLDH,lacticacid,CRP,TNF,Ig,NSEdeterminations,Examinations,3.Otherexaminations(1)bloodculture:beforeantibiotictherapy(2)petechiasmear:epidemiccerebrospinalmeningitis(3)othersecretioncultures:(4)imaging:CT&MRI,Diagnosis,Earlierdiagnosisandpromptinitiationofeffectiveantibiotictreatmentiscriticalforminimizingsequelaeofpurulentmeningitis.Suspectedcases:febrileinfantswithseizure,meningealirritation,increasedintracranialpressure,alteredmentalstatusPayattentiontotheatypicalsymptomsandsignsinneonate,infantandpatientalreadyreceivedirregularantibiotictherapy,Diagnosis,Diagnosisisconfirmedbyanalysisofcerebrospinalfluid(CSF)SuggestionbacterialmeningitisIncreasedpressure(90%)Appearance:slightlycloudytopurulentRaisedwhitebloodcells,consistingchieflyofpolymorphonuclearleukocytesRaisedproteinconcentration,Decreasedglucoseconcentration(80%),Diagnosis,Confirmationofthediagnosis:isolationfromtheCSFofaspecificbacterialpathogenbymicroscopyorapositivecultureorrapidantigen-detectiontestofCSFGram-stainedsmearofCSF:identifythecausativeorganismin70-90%ofcasesCSFculture:positiveinabout80%ofcases.definitivediagnosis,determinationofantibioticsensitivity.PCR:amplifiesbacterialDNA(Hinfluenzae,N.meningitidis),Differentialdiagnosis,Viralmeningitis/encephalitis:LessseveresystemicinfectioussymptomsUsuallynotdevelopafter2-3weeksCSF:normalglucoseTuberculousmeningitis:SubacuteonsetandprogressAhistoryofclosecontactwithknowncasesoftuberculosisEvidenceofacuteorhealedtubercularinfectiononchestx-rayTuberculinskintest:OT,PPDCSF,Differentialdiagnosis,Cryptococcalmeningitis:slowonset,alongcourseofdisease,increasedintracranialpressuresevereheadacheCSFchanges:similarwithtuberculousmeningitisconfirmedbyIndiainkstainingorcultureofCSFMollaretsmeningitis:etiology:unknowclinicalmanifestationsandCSF:recurrent,similartopurulentmeningitisCSF:Mollaretscellsadrenocorticalhormonetherapy:effective,Differentialdiagnosis,Brainabscess:slowonsetCSF:pressure,cellnormalor,proteinfurtherdiagnosis:CTorMRIAcutetoxicencephalopathy:manifestations:delirium,convulsions,coma,meningealirritation,cerebralpalsyCSF:onlypressure,Treatment,1.AntibacterialtherapyTherapyprinciples:earlytreatment,antibioticssusceptibletopathogensandwithhighpermeabilitythroughBBB,givenintraveninously,enoughdose,enoughcourseofantibiotictherapy,Treatment,atthetimeofunknownpathogenicbacteria:Firstchoice:Cefotaxime,Ceftriaxone(3drgenerationofcephalosporins,highpermeabilitythroughBBB,productsofmetabolismalsohaseffect,CSFsterilizationwithin24h)Otherchoice:Penicillin,Chloramphenicol,(sideeffects:graybabysyndromeandbonemarrowsuppression)atthetimeofknownpathogenicbacteria:refertodrugsensitivitytest,Antibiotictherapyofbacterialmeningitis,Treatment,2.Adrenalcorticalhormone:dexamethasone:0.3-0.5mg/kg/day3.Symptomatictreatment&supportivecareIncreasedintracranialpressure:Intravenousmannitol0.5-1g/kg/everytime,q4-6hConvulsions:diazepam&chloralhydrate&phenobarbitalFever:Acetaminophen&ibuprofenMaintenancefluidandthermalenergysupplement:fluidadministration:60-80ml/kg/dayfluidinfusionwithdehydrationtherapy,Treatment,4.TreatmentofcomplicationsSubduraleffusionFewvolumecouldbeabsorbedwithtrea
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 中国竹代尔纤维项目商业计划书
- 中国自粘型保护膜项目商业计划书
- 中国磨砂玻璃项目投资计划书
- 赤峰市中医院科室沟通协调能力考核
- 2025第三人民医院临时修复体制作考核
- 乌海市人民医院富血小板血浆应用考核
- 巴彦淖尔市人民医院护理危机处理考核
- 中国非蛋白氮饲料添加剂项目创业计划书
- 朔州市人民医院科室护理质量管理考核
- 朔州市中医院护理质量数据分析考核
- 2025至2030中国船员服务市场发展态势及前景规划研究报告
- 五六年级男生青春期健康教育讲课件
- 拳击比赛裁判员培训教程
- 参考儿科急危重症抢救预案及流程
- 2025至2030年中国眼科专科医院行业市场发展模式及战略咨询研究报告
- 2025西南证券股份有限公司招聘43人(重庆)笔试参考题库附带答案详解析集合
- 关于医院“十五五”发展规划(2026-2030)
- T/CHTS 10130-2024高韧超薄沥青磨耗层技术指南
- 活动人员分工安排方案
- 带娃上班免责协议书
- 车祸理赔电子协议书模板
评论
0/150
提交评论