在诊断急性社区获得的细菌性脑膜炎的困境
Matthijs C Brouwer1, Guy E Thwaites, Allan R Tunkel
1Department of Neurology, Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands.
Lancet (London, England)
|November 13, 2012
概括
快速诊断急性细菌性脑膜炎是减少死亡和长期问题的关键. 然而,不寻常的症状和诊断测试限制等挑战往往导致患者护理的延迟.
科学领域:
- 传染性疾病 传染性疾病
- 神经学 神经学
- 临床微生物学 临床微生物学
背景情况:
- 社区获得的急性细菌性脑膜炎需要快速诊断和治疗,以尽量减少死亡率和神经系统的后果.
- 诊断挑战来自于异常表现,腰部刺穿的安全性评估,以及标准微生物学测试的有限灵敏度.
- 临床评估和脑脊液 (CSF) 检查至关重要,但由于发现的变化,需要仔细解释.
研究的目的:
- 审查急性社区感染细菌脑膜炎的诊断困境.
- 强调诊断中临床评估和CSF检查的重要性和解释.
主要方法:
- 对疑似细菌性脑膜炎的临床评估结果的审查.
- 脑脊液 (CSF) 检查结果的分析及其解释.
- 讨论结合临床和测试数据的诊断预测模型.
主要成果:
- 病史和体检本身往往不足以确定确诊.
- 腰部穿刺虽然是必不可少的,但由于需要先进行脑部成像,因此可能会被推迟.
- 脑脊髓异常可能是可变的,受致病原体,患者人口统计学,免疫状况和先前治疗的影响.
结论:
- 在怀疑急性细菌性脑膜炎时,诊断困境是常见的.
- 临床评估和CSF分析是诊断的核心,但需要仔细,取决于上下文的解释.
- 诊断预测模型可以帮助,但在区分细菌性脑膜炎方面并非无误.
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