中樞神經(jīng)系統(tǒng)感染-2ppt(編輯修改稿)
2024-10-04 13:34 本頁面
【文章內(nèi)容簡介】 polymerase chain reaction (PCR) 聚合酶鏈反響 has also been used for diagnosis. 第二十八頁，共六十八頁。 ? Finally, the CT scan may show contrast enhancement of the basal cisterns and cortical meninges, or hydrocephalus. 第二十九頁，共六十八頁。 ? MRI appearance of the typical pattern of central nervous system tuberculous meningitis 第三十頁，共六十八頁。 Differential Diagnosis ? Many other conditions can a subacute confusional state with mononuclear cell單核細胞 pleocytosis 腦脊液細胞增多 , 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 細胞學(xué)檢查 . 第三十一頁，共六十八頁。 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、 對癥治療。藥物治療原那么：早期、聯(lián)合、足量、長期、頓服 第三十二頁，共六十八頁。 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，共六十八頁。 ? 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，共六十八頁。 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，共六十八頁。 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，共六十八頁。 ? The
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