中枢神经系统感染-2 课件.ppt

The polymerase chain reaction (PCR) 聚合酶链反应 has also been used for diagnosis. Finally, the CT scan may show contrast enhancement of the basal cisterns and cortical meninges, or hydrocephalus. MRI appearance of the typical pattern of central nervous system tuberculous meningitis Differential Diagnosis Many other conditions can a subacute confusional state with mononuclear cell单核细胞 pleocytosis 脑脊液细胞增多, including syphilitic 梅毒的, fungal, neoplastic 肿瘤的, and partially treated bacterial meningitis. These can be diagnosed by appropriate smears 涂片, cultures, and serologic 血清学的 and cytologic examinations 细胞学检查. Treatment Treatment should be started as early as possible; it should not be withheld while awaiting culture results. The decision to treat is based on the CSF findings described above; lymphocytic pleocytosis and decreased glucose are particularly suggestive, even if acid-fast smears are negative. 综合治疗：药物治疗、 全身支持 、并发症的预防 、耐药与多耐药TB菌感染的治疗、 对症治疗。药物治疗原则：早期、联合、足量、长期、顿服 DRUGS Four drugs are used for initial therapy, until culture and susceptibility test results are known. 四联治疗 isoniazid, 异烟肼 300mg; rifampin, 利福平 600mg; pyrazinamide, 吡嗪酰胺 25mg/kg; ethambutol, 乙胺丁醇 15mg/kg, each given orally once daily. For susceptible strains, ethambutol乙胺丁醇can be discontinued, and triple therapy continued for 2 months, followed by 4-10 months of treatment with isoniazid异烟肼and rifampin利福平alone. Pyridoxine,维生素B6 50mg/d, can be used to decrease the likelihood可能性of isoniazid-induced polyneuropathy. Side effect of drugs Complications of therapy include ： hepatic 肝脏的dysfunction (isoniazid异烟肼, rifampin利福平, and pyrazinamide吡嗪酰胺 ) polyneuropathy多神经炎 (isoniazid) optic neuritis (ethambutol乙胺丁醇) seizures (isoniazid) ototoxicity 耳毒性(streptomycin链霉素) Corticosteroids Prednisone 泼尼松60mg/d orally in adults or 1-3 mg/kg/d orally in children, tapered gradually over 3-4 weeks Corticosteroids are indicated as adjunctive 辅助的therapy in patients with spinal subarachnoid block. They may also be in