感染病学（上海交通大学）流行性脑脊髓膜炎

MeningococcalMeningitis流行性脑脊髓膜炎meningococcalmeningitisIntroduction亚撒哈拉非洲被称为'MeningitisBelt'.不管是兴旺国家，还是开展中国家，80%的细菌性脑膜炎由3种致病菌引起:HaemophilusinfluenzaetypeB(Hib),StreptococcuspneumoniaeandNeisseriameningitidismeningococcalmeningitisIntroduction

meningitidis,thecausativeorganismofmeningococcalmeningitis,wasfirstisolatedfromcerebrospinalfluidanddescribedin1887byWeichselbaummeningococcalmeningitisIntroduction

感染涉及：脑膜炎、菌血症、呼吸道、关节、心包、眼、泌尿生殖系等主要临床表现：FeverHeadacheVomiting

Neckstiffness

AdiffusemaculopapularrashJointpainPhotophobiameningococcalmeningitisBacteriaTheNeisseriafamilyismadeupofmorethan10species.Only2ofthemareofclinicalimportance

N.gonorrhoeae,responsibleforgonorrhea,N.meningitidis,responsibleformeningococcaldisease.meningococcalmeningitisBacteriaG-，‘diplococci’，φ0.6~1.0μmCanbefoundinblood,CSF,purpurameningococcalmeningitisBacteriameningococcalmeningitisBacteria专性需氧菌巧克力色血琼脂平板5%-10%CO2meningococcalmeningitisBacteria

A,B,C,

D,E29,H,I,K,L,W135,X,YZA占90%以上meningococcalmeningitisDistributionofpredominantN.meningitidisserogroups(A,B,C),1996–1997Source:Can.Commun.Dis.Rep.1999;25(ACS-5)/(DDC-5)][98]meningococcalmeningitisBacteriaEndotoxin致病因素自溶酶及时培养meningococcalmeningitisEpidemiologySourceTheonlynaturalhostofmeningococcusisman.Becausenasopharyngealcarriageofmeningococciissomuchmorefrequentthanmeningococcaldisease,nasopharyngealcarriers,ratherthanpatientswithmeningitis,aretheusualsourceofnewinfections.meningococcalmeningitisEpidemiologyTransmissionwayTransmissionofN.meningitidisdirectlyfrompersontoperson,occursbythedropletspreadofnasopharyngealsecretions〔经呼吸道传播〕Throughcloseoralcontact(密切接触传播)meningococcalmeningitisEpidemiologyRiskGroupsmokers,peoplewholivedinovercrowdedhouseholds,andmilitaryrecruits.5岁以下儿童,尤其是6月龄~2岁.老年人.meningococcalmeningitisEpidemiologyEpidemiccharacteristicSeasonandPeriodicity全年发病多见于11月~5月，3~4月顶峰流行周期不如过去明显meningococcalmeningitisEpidemicsofMeningococcalmeningitis,1971–1997

meningococcalmeningitisPathogenesis细菌

咽喉部呼吸道上呼吸道感染宿主抵抗力细菌毒力携带者菌血症脑脊髓膜化脓性性脑膜炎其他器官心包或关节等

meningococcalmeningitisPathogenesis内毒素小血管瘀斑感染性休克DIC出血脑水肿脑部化脓昏迷脑疝meningococcalmeningitisAnato-PathologySepticemiastage血管内皮损害心肌炎和肺水肿血管壁炎症、坏死血栓形成、血管周围出血皮肤粘膜出血脏器出血Anatomie-Pathologiquemeningococcalmeningitis

Anato-PathologyMeningitisstage软脑膜和蛛网膜血管充血、出血、水肿颅压升高FP、NE、Plasma外渗CSF混浊颅底炎症、粘连颅神经损害meningococcalmeningitismeningococcalmeningitisAnato-PathologyMeningitisstage爆发型脑实质坏死、充血、出血、水肿颅压↑脑疝慢性病人脑室孔阻塞CSF循环障碍脑积水meningococcalmeningitismeningococcalmeningitisClinicalManifestationTheaverageincubationperiodvariesfrom1-10days(2~3days).meningococcalmeningitisClinicalManifestationOrdinarytype(>90%cases)Nasopharynxrestrictedstage持续1~2天上呼吸道感染表现多数病人无此期表现Septicaemiastage急起高热39~40℃头痛皮肤粘膜淤点淤斑meningococcalmeningitismaculopapularrashmeningococcalmeningitisClinicalManifestationOrdinarytypeMeningitisstage多与败血症同时出现中枢神经系统病症脑膜刺激症意识障碍、抽搐持续2~5天Convalescencestage体温下降，病症消失幸福疱疹meningococcalmeningitisClinicalManifestationFulminantTypeShockType典型脑膜炎急性表现瘀点瘀斑广泛，融合休克表现脑膜刺激症可缺如脑脊液不典型，但培养多阳性meningococcalmeningitismeningococcalmeningitisClinicalManifestationFulminantTypeMeningo-encephalitis脑实质损害脑疝枕骨大孔疝:又称小脑扁桃体疝.幕下的小脑扁桃体及延髓经枕骨大孔被挤向椎管内以延髓急性损害病症为主,生命体征改变.天幕裂孔疝:又称小脑幕切迹疝.幕上的脑组织(颞叶的海马回、钩回)通过小脑幕切迹被挤向幕下.初起时病侧瞳孔略缩小，光反响稍迟钝，以后病侧瞳孔逐渐散大，略不规那么，直接及间接光反响消失，健侧肢体瘫痪。MixedtypemeningococcalmeningitismeningococcalmeningitisClinicalManifestationMildTypefever,jointpainandsymptomsofanupperrespiratoryinfection.LessrashChildrenandOldmanmeningococcalmeningitisLabBloodroutineWBC↑↑↑，NE↑↑CSF混浊，WBC>1000X106/L，多核为主Pr↑,Glu↓Cl-↓颅压↑meningococcalmeningitisLUMBERPUNCTUREmeningococcalmeningitisLabBacteriology涂片meningococcalmeningitisLabBacteriology培养meningococcalmeningitisLabImmunologyAntigeneAntibodyOthersCSF-β2-microglobulinCST-LDHmeningococcalmeningitisComplicationsandpersistingsequelaeDiagnosisanddifferentdiagnosisDiagnosis季节，突发高热，头痛，呕吐瘀斑，脑膜刺激症血、脑脊液检查，细菌培养Differentdiagnosis其他细菌病毒脑，结