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polymerase chain reaction (PCR) 聚合酶鏈反響 has also been used for diagnosis. 第二十八頁(yè),共六十八頁(yè)。 ? Finally, the CT scan may show contrast enhancement of the basal cisterns and cortical meninges, or hydrocephalus. 第二十九頁(yè),共六十八頁(yè)。 ? MRI appearance of the typical pattern of central nervous system tuberculous meningitis 第三十頁(yè),共六十八頁(yè)。 Differential Diagnosis ? Many other conditions can a subacute confusional state with mononuclear cell單核細(xì)胞 pleocytosis 腦脊液細(xì)胞增多 , including syphilitic 梅毒的 , fungal, neoplastic 腫瘤的 , and partially treated bacterial meningitis. These can be diagnosed by appropriate smears 涂片 , cultures, and serologic 血清學(xué)的 and cytologic examinations 細(xì)胞學(xué)檢查 . 第三十一頁(yè),共六十八頁(yè)。 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 acidfast smears are negative. 綜合治療:藥物治療、 全身支持 、并發(fā)癥的預(yù)防 、耐藥與多耐藥 TB菌感染的治療、 對(duì)癥治療。藥物治療原那么:早期、聯(lián)合、足量、長(zhǎng)期、頓服 第三十二頁(yè),共六十八頁(yè)。 DRUGS ? Four drugs are used for initial therapy, until culture and susceptibility test results are known. 四聯(lián)治療 ? isoniazid, 異煙肼 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. 第三十三頁(yè),共六十八頁(yè)。 ? For susceptible strains, ethambutol乙胺丁醇 can be discontinued, and triple therapy continued for 2 months, followed by 410 months of treatment with isoniazid異煙肼 and rifampin利福平 alone. ? Pyridoxine,維生素 B6 50mg/d, can be used to decrease the likelihood可能性of isoniazidinduced polyneuropathy. 第三十四頁(yè),共六十八頁(yè)。 Side effect of drugs Complications of therapy include : ? hepatic 肝臟的 dysfunction (isoniazid異煙肼 , rifampin利福平 , and pyrazinamide吡嗪酰胺 ) ? polyneuropathy多神經(jīng)炎 (isoniazid) ? optic neuritis (ethambutol乙胺丁醇 ) ? seizures (isoniazid) ? ototoxicity 耳毒性 (streptomycin鏈霉素 ) 第三十五頁(yè),共六十八頁(yè)。 Corticosteroids ? Prednisone 潑尼松 60mg/d orally in adults or 13 mg/kg/d orally in children, tapered gradually over 34 weeks ? Corticosteroids are indicated as adjunctive 輔助的 therapy in patients with spinal subarachnoid block. ? They may also be indicated in seriously ill patients with focal neurologic signs or with increased intracranial pressure from cerebral edema. 第三十六頁(yè),共六十八頁(yè)。 ? The