第五章 第十三节 流行性脑脊髓膜炎

nullMeningococcal Meningitis Meningococcal Meningitis 流行性脑脊髓膜炎meningococcal meningitismeningococcal meningitisIntroduction 亚撒哈拉非洲被称为 'Meningitis Belt'. 不论是发达国家，还是发展中国家， 80% 的细菌性脑膜炎由3种致病菌引起: 乙型流感嗜血杆菌, 肺炎链球菌 and Neisseria meningitidis meningococcal meningitismeningococcal meningitisIntroduction meningitidis, the 病原微生物 of meningococcal meningitis, was first 分离 from 脑脊液 and described in 1887 by Weichselbaum meningococcal meningitismeningococcal meningitisIntroduction 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： Fever Headache 呕吐 颈强直 弥散性斑丘疹 Joint pain 畏光 meningococcal meningitismeningococcal meningitisBacteria The Neisseria family is made up of more than 10 species. Only 2 of them are of clinical importance 淋病奈瑟菌, responsible for gonorrhea, N. meningitidis, responsible for meningococcal disease. meningococcal meningitismeningococcal meningitisBacteria G- ， ‘双球菌’ ， φ0.6~1.0μm Can be found in blood, CSF, 紫癜 meningococcal meningitismeningococcal meningitisBacteria meningococcal meningitismeningococcal meningitisBacteria 专性需氧菌 巧克力色血琼脂平板 5%-10% CO2 PH 7.4-7.6meningococcal meningitismeningococcal meningitisBacteria A, B, C, D, E29, H, I, K, L, W135, X, Y ZA占90%以上meningococcal meningitismeningococcal meningitisDistribution of 主要的 N. meningitidis serogroups (A, B, C), 1996–1997 Source : Can. Commun. Dis. Rep. 1999 ; 25(ACS-5)/(DDC-5)] [98]meningococcal meningitismeningococcal meningitisBacteria 内毒素 致病因素 自溶酶 及时培养 meningococcal meningitismeningococcal meningitisEpidemiology Source The only natural host of meningococcus is man. Because 鼻咽部携带者 of meningococci is so much more frequent than meningococcal disease, 鼻咽部携带者, rather than patients with meningitis, are the usual source of new infections. meningococcal meningitismeningococcal meningitisEpidemiology Transmission way Transmission of N. meningitidis directly from person to person, occurs by the 飞沫传播 of 鼻咽分泌物 （经呼吸道传播） Through close oral contact (密切接触传播)meningococcal meningitismeningococcal meningitisEpidemiology Risk Group smokers, people who lived in 过度拥挤的家庭, and 新兵. 5岁以下儿童, 尤其是6月龄~2岁. 老年人.meningococcal meningitismeningococcal meningitisEpidemiology Epidemic characteristic Season and 周期性 全年发病 多见于11月~5月，3~4月高峰 流行周期不如过去明显meningococcal meningitismeningococcal meningitisEpidemics of Meningococcal meningitis, 1971–1997 meningococcal meningitis meningococcal meningitis发病机制 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脑膜炎其他器官心包或关节等 meningococcal meningitis meningococcal meningitisPathogenesis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meningococcal meningitismeningococcal meningitisAnato-Pathology 败血症期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-PathologiqueAnatomie-Pathologiquemeningococcal meningitismeningococcal meningitis Anato-Pathology 脑膜炎期 软脑膜 和 蛛网膜血管充血、出血、水肿颅压升高FP、NE、血浆外渗CSF混浊颅底炎症、粘连颅神经损害meningococcal meningitismeningococcal meningitismeningococcal meningitismeningococcal meningitisAnato-Pathology Meningitis stage暴发型脑实质坏死、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meningococcal meningitismeningococcal meningitismeningococcal meningitismeningococcal meningitisClinical Manifestation The average incubation period varies from 1-10 days (2~3days).meningococcal meningitismeningococcal meningitisClinical Manifestation Ordinary type( >90% cases ) Nasopharynx restricted stage 持续1~2天 上呼吸道感染表现 多数病人无此期表现 Septicaemia stage 急起高热39~40℃ 头痛 皮肤粘膜淤点淤斑 meningococcal meningitismeningococcal meningitis斑丘疹 meningococcal meningitismeningococcal meningitisClinical Manifestation Ordinary type Meningitis stage 多与败血症同时出现 中枢神经系统症状 脑膜刺激症 意识障碍、抽搐 持续2~5天 Convalescence stage 体温下降，症状消失 幸福疱疹 meningococcal meningitismeningococcal meningitisClinical Manifestation 暴发型 Shock Type 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meningococcal meningitismeningococcal meningitismeningococcal meningitismeningococcal meningitisClinical Manifestation Fulminant Type 脑膜脑炎型 脑实质损害 脑疝 枕骨大孔疝 天幕裂孔疝 Mixed typemeningococcal meningitismeningococcal meningitismeningococcal meningitismeningococcal meningitisClinical Manifestation 轻型 fever, joint pain and symptoms of an upper respiratory infection. 少量出血点 Children and Old manmeningococcal meningitismeningococcal meningitisLab 血常规 WBC↑↑↑，NE↑↑ CSF 混浊，WBC>1000X106/L，多核为主 Pr↑, Glu↓ Cl-↓ 颅压↑meningococcal meningitismeningococcal meningitis腰穿meningococcal meningitismeningococcal meningitisLab 细菌学 涂片meningococcal meningitismeningococcal meningitisLab Bacteriology 培养meningococcal meningitismeningococcal meningitisLab Immunology Antigene Antibody Others CSF-Β2mg LLTmeningococcal meningitismeningococcal meningitis并发症及后遗症 Diagnosis and different diagnosis Diagnosis 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 Different diagnosis 其他细菌 病毒脑，结脑，梅脑 败血症休克型meningococcal meningitismeningococcal meningitismeningococcal meningitismeningococcal meningitisTreatment 普通型 一般治疗 病原治疗 对症治疗 暴发型 休克型：纠正休克 脑膜脑炎型：减轻脑水肿，防脑疝 meningococcal meningitismeningococcal meningitisPrevention 传染源 传播途径 易感人群 菌苗注射 SMZconull