病例报告-细菌性脑膜炎（Case report Bacterial Meningitis）.pptVIP

Case report Boy, 6 yrs, admitted in 23, Apr. 2005. CC: Fever, headache and vomiting for 2 days. HPI: Fever (T 39℃), headache, malaise, anorexia, vomiting (2), no convulsion skin rash. PMH: “Bacterial meningitis” (2 times in 17 months). PE: Left hearing loss, obvious neck stiffness with positive Brudzinskis and Kernigs signs. BR: WBC 14.56×109/L, N 86%, Hb 120g/L Q1: What disease does this boy suffer from? Diagnosis differential diagnosis for this boy Fever------infection, connective tissue diseases, malignancy (leukemia), Kawasaki disease …… Headache vomitting------intracranial hypertension, digestive tract infection, influenza (GI type) …… Neck stiffness with Brudzinskis and Kernigs signs (+) ------ meningeal irritation (meningitis or hemorrhage of subarachnoid space) BR: WBC↑, N↑------bacterial infection Bacterial meningitis Bacterial Meningitis Objectives Definition Etiology Pathway of invasion Pathology Pathogenesis Clinical manifestations (CSF findings) Complications and their managements Essentials of diagnosis Differential diagnosis with viral, tuberculous cryptococcal meningitis Treatment What is meningitis? Other pathogens (in younger babies (2mon) neonates, and immunocompromised individuals) G－ enteric bacilli Escherichia Coli 埃希大肠杆菌, Proteus 变形杆菌, Pseudomonas pyocyanea 绿脓杆菌, Aerobacter 产气杆菌 (2) Staphylococcus aureus 金葡菌(pyosapremia) (3) Group B streptococcus (rare in China) Modes of Entry Hematogenous spread (bacteremia / pyosapremia) Invading entrance: respiratory/digestive tracts skin/mucosa (umbilical region) Spread of infection from a contiguous site (otitis media, paranasal sinusitis, mastoiditis) Anatomical disruption (trauma, basal skull fracture, congenital dermal sinus) Mechanism of Bacterial Entry What is meningitis? (pathology) Congestion, fibrous exudation, neutrophil infiltration, angioedema and cytotoxic edema Focal hemorrhage (necrosis of vessel wall) Focal