大人的急性细菌脑膜炎
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
概括
尽管有进展, 细菌性脑膜炎仍然是成年人的严重威胁. 未来对抗这种感染的进展取决于疫苗和宿主反应调节, 不仅仅是抗生素.
科学领域:
- 传染性疾病
- 神经学
- 微生物学
背景情况:
- 细菌性脑膜炎的发病率在儿童中有所下降,但在成年人中仍然是一个重大问题,死亡率高达30%.
- 虽然致病性尚未完全阐明,但对细菌进入中枢神经系统 (CNS) 的理解正在进步.
- 仅仅临床症状是诊断不足的;脑脊液分析至关重要.
研究的目的:
- 审查目前对细菌性脑膜炎的理解,重点是诊断,治疗和未来的方向.
- 突出目前治疗方法的局限性,并探索潜在的新方法.
- 强调疫苗在长期减少疾病中的作用.
主要方法:
- 对细菌脑膜炎发病,诊断和治疗的现有文献的审查.
- 对多重PCR,蛋白质组学和基因测序等新兴诊断技术进行讨论.
- 分析辅助疗法及其对患者结果的影响.
主要成果:
- 尽管抗菌疗法得到了改进,但死亡率仍然很高,需要探索辅助治疗.
- 在特定情况下,辅助性皮质类固醇已被证明是有益的.
- 新的诊断工具有望更快,更准确地识别细菌性脑膜炎.
结论:
- 预计通过调节宿主反应或新的治疗策略,而不是仅仅依靠新的抗生素,细菌性脑膜炎的结果将进一步改善.
- 广泛的保护性疫苗是减少全球细菌脑膜炎负担的最有前途的长期策略.
- 为了改善患者护理, 必须继续研究病原和诊断.
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