大人の急性細菌性髄膜炎

Fiona McGill¹, Robert S Heyderman², Stavros Panagiotou³

¹Institute of Infection and Global Health, University of Liverpool, Liverpool, UK; NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK; Leeds University Hospitals NHS Trust, Leeds, UK; Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

Lancet (London, England)

|June 7, 2016

まとめ

細菌性髄膜炎は進歩にもかかわらず大人の深刻な脅威ですこの感染症との闘いにおける将来の進歩は抗生物質だけでなくワクチンと宿主反応の調節に依存しています

科学分野:

感染症
神経学
微生物学

背景:

細菌性髄膜炎の発生率は子供では減少しているが,成人では依然として深刻な問題であり,死亡率は30%まで上昇している.
病原性は完全に解明されていないが,中枢神経系 (CNS) への細菌の侵入の理解は進んでいる.
臨床的症状だけでは診断には不十分であり,脳脊髄液の分析が不可欠である.

研究の目的:

バクテリア性髄膜炎の現在の理解をレビューし,診断,治療,将来の方向性に焦点を当てます.
現在の治療法の限界を強調し,新しいアプローチを探求する.
長期にわたる病気の減少におけるワクチンの役割を強調する.

主な方法:

細菌性髄膜炎の病原性,診断,治療に関する既存の文献のレビュー.
マルチプレックスPCR,プロテオミクス,遺伝子シーケンシングなどの新興診断技術の議論
補助療法と患者の治療結果への影響の分析

主要な成果:

抗菌薬の治療が改善されたにもかかわらず,死亡率は依然として高く,補助的な治療の探求が必要である.
補助的なコルチコステロイドは,特定のケースで有益であることが示されています.
細菌性髄膜炎をより早く正確に特定できるという新しい診断ツールがあります

結論:

細菌性髄膜炎の結果のさらなる改善は,新しい抗生物質のみに頼るのではなく,宿主反応または新しい治療戦略を調節することによって予想されます.
広範囲にわたる予防接種は細菌性髄膜炎の世界的負担を減らすための最も有望な長期戦略です
患者のケアを改善するために病原性と診断に関する研究を継続することが不可欠です

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