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題 名 | Diagnostic Approach to Recurrent Bacterial Meningitis in Children=兒童復發細菌性腦膜炎的診斷方針 |
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作 者 | 王煇雄; 郭夢菲; 黃嵩雀; | 書刊名 | 長庚醫學 |
卷 期 | 28:7 2005.07[民94.07] |
頁 次 | 頁441-452 |
分類號 | 415.9313 |
關鍵詞 | 細菌性腦膜炎; 顱底腦膨出; 腦脊髓液滲漏; 免疫缺陷; 復發性腦膜炎; 沙門氏菌腦膜炎; Bacterial meningitis; Basal encephalocele; Cerebrospinal fluid leakage; Immunodeflciency; Recurrent Meningitis; Salmoella Meningitis; |
語 文 | 英文(English) |
中文摘要 | 兒童復發細菌性腦膜炎不僅潛藏致命的危機,病童因需一再住院接受許多侵襲性檢查,以便找到導致腦膜炎復發的病因而產生心理挫傷,也不容忽視。正常的中樞神經系統為周密的骨骼及腦膜包圍保護著,先天或後天(外傷、手術)的硬腦膜缺陷使細菌易於一再侵入,因而兒童復發細菌性腦膜炎時確定有無硬腦膜缺陷的存在與位置為最首要;腦脊髓液從鼻、耳滲漏出的機會並不大,到是顏面或背部的異樣有時暗示著硬腦膜缺陷的可能位置。為了找得到潛到的病灶,常需合併用到所有現代化影像檢查。同時施以正確的外科硬腦膜縫合術治療到滴水不漏,才足以避免腦膜炎又再復發。顱底的膨出(basal encephalocele)、脊髓或後腦窩通到皮膚或消化道的廔管(sinus tract或neurenteric cyst)等雖都罕見,但在某些東南亞地區高達每五千名活產兒就有一例顱底腦澎出;另外常合併扯髓(tethered cord)的脊髓病變,用前瞻性的外科治療可避免將來產生進行性的下肢和排尿問題。沒有解剖構上的病灶時,免疫缺陷是接下來診斷努力的方向,這類病人平時就經常一再感染,除了免疫球蛋白或補體不足之外,無脾症(asplenia)也是腦膜炎復發的病因之一。至於像沙門氏桿菌引起的腦膜炎,常常因抗生素治療不足三週以上,而於停藥不久就出現類似復發的現象,臨床醫師不能不謹慎。 |
英文摘要 | Recurrence of bacterial meningitis in children is not only potentially life-threatening, but also involves or induces psychological trauma to the patients through repeated hospitalization and multiple invasive investigations if the underlying cause remains undetected. Bacteria migration, along congenital or acquired pathways from the skull or spinal dural defects, should be taken into consideration when children face recurrent bacterial meningitis, however, symptoms and signs of cerebrospinal fluid (CSF) rhinorrhea or otorrhea are rare in such patients. Without evidence of CSF leakage, a cranial symptom/sign or coccygeal cutaneous stigmata may suggest the approximate lesion site, diagnosis and detection remains difficult. To detect an occult dural lesion along the creniospinal axis, such as basal encephalocele, dermal sinus tract, or neurenteric cyst, a detailed clinical evaluation and the use of the modern diagnostic imaging methods is necessary. Because of the possibility of concomitant occurrence of more than one malformation, both the frontal the lateral skull base should be carefully evaluated. Precise location of the dural lesion is a prerequisite surgical repair. In addition, the bacteria specificity could leave significant clues: Pneumoccocus or Hemophilus suggests cranial dural defects, E. coli or other gram negative bacilli suggests spinal dural defects, and meningoccocci suggest immunologic deficiency. Asplenia or immunoderficiency such as complement or immunogobuin deficiency rarely causes recurrent meningitis with out a history of frequent infection of non-CNS areas. Salmonella meningitis or brain abscess should not be treated incompletely or inadequately and could lead to recrudescence, relapse or recurrence of bacterial meningitis. Antibiotic (penicillin or trimethoprim0-sulfamethoxazole) induced meningitis may repetitively occur on occasion. |
本系統中英文摘要資訊取自各篇刊載內容。