结核性脑膜炎43例临床分析

结核性脑膜炎是一种常见的中枢神经系统感染性疾病。结核菌感染多由血循环进入颅内,形成脑部小病灶,以后破裂而蔓延,波及软脑膜、蛛网膜及脑室,临床以脑膜损害症状为主,表现为头痛、恶心、呕吐、脑膜刺激征阳性等,腰穿脑脊液检查可出现相应改变。当结核炎症波及脑血管时,可引起     

寄生虫与中枢神经系统疾病的研究

<正>各种病原体所致中枢神经系统感染皆属临床重症。寄生虫引起的中枢神经系统感染常与其它中枢神经系统疾病混淆,且易被临床医生忽视。这些感染中有些是以中枢神经系统病变为主,如原发性阿米巴脑膜脑炎、弓形虫病、广州管圆线虫病、非洲锥虫病:有些感染经常侵犯中枢神经系统,如疟疾、并殖吸虫病、囊尾蚴病;而有些则偶可侵犯中枢神经系统,如阿米巴病、曼氏裂头蚴病、血吸虫病、脑包虫病、旋毛虫病等:而有些节肢动物与人体中枢神经系统关系较为密切。对这些疾病的认识有助于对具有中枢神经系统病变的诊断和鉴别诊断。     

神经梅毒29例临床分析

<正>梅毒(syphilis)是由无芽胞杆菌属苍白密螺旋体(treponemapallidum,TP)感染引起的全身性感染性疾病,主要通过性接触感染,也可通过间接接触及血液传播途径、母婴传播途径而感染。近年来梅毒发病率有增高趋势。神经梅毒为梅毒螺旋体感染引起大脑、脑膜或脊髓损害的临床综合征。未经治疗的早     

小儿化脓性脑膜炎的临床护理对策

化脓性脑膜炎是由各种化脓性的细菌感染引起的中枢神经系统急性感染性疾病.尤以婴幼儿感染常见,由各种化脓细菌引起的脑膜炎症,以发热、头痛、呕吐、意识障碍、脑膜刺激征、婴儿前囟饱满、脑脊液混浊及细菌学检查阳性为其特征.其病死率即神经系统后遗症较多,是小儿时期严重感染性疾病之一.     

中枢神经系统细菌性感染宜选用哪些抗菌药?

中枢神经系统细菌性感染宜选用哪些抗菌药？中枢神经系统细菌性感染的死亡率高，正确及时地应用抗菌药乃是治疗成败的关键。１选用杀菌剂　　由于血脑屏障的存在和淋巴系统的缺如，宜选用杀菌剂以有效杀灭病原菌。氯霉素虽属抑菌剂，但脂溶性强，脑膜对其渗透好，高浓度时...     

以神经梅毒为首发的梅毒的临床特点及护理

梅毒是苍白密螺旋体感染所致的全身感染性疾病,多经性传播疾病。近年来,梅毒感染发病人数呈上身趋势。神经梅毒系由感染人体后出现的大脑、脑膜或脊髓损害的一组临床综合征,约10%可在初次感染后3～20年发病。现将宁波市医疗中心李惠利医院2005年     

重症结核性脑膜脑炎63例临床分析

结核性脑膜脑炎是常见的中枢神经系统感染性疾病[1],其临床表现不典型,症状和体征多样化,常常因此而得不到及时诊断和治疗。重症结核性脑膜脑炎患者并发症多,预后差,病死率高[2]。为了探讨重症结核性脑膜脑炎的临床特点和诊治经验,笔者对本院近3年来收治的此类患者的诊治情况作一回顾性分析。     

肺支原体感染合并肝功能损害42例临床分析

肺炎支原体(MP)是呼吸道感染性疾病的常见病原体,近年来发病率有增加趋势,其不仅引起呼吸系统的损害,也可引起广泛而多样的多系统临床表现,目前有关MP感染致多器官系统损害的研究,越来越引起临床医生的重视[1].现收集本院2006年8月至2008年9月肺炎支原体IgM抗体阳性合并肝功能损害患者的临床资料,对其感染特点进行临床回顾性分析报道如下.     

儿童肺炎支原体脑炎(附3例报告)

肺炎支原体作为一种常见的呼吸道感染病原,已被人们熟知.近十余年来其肺外损害逐渐被发现并受到关注.中枢神经系统损害病情相对严重,已经受到越来越多的儿科医生的重视.然而由于认识的局限性.往往不能及时正确地做出诊断和治疗.本文报道我院近年确诊的3例典型病例,以期更好的总结经验教训.……     

小脑顶核电刺激联合康复训练治疗乙脑后遗症

流行性乙型脑炎（epidemic encephalitis B）简称乙脑，是由嗜神经的乙脑病毒所致的中枢神经系统感染性疾病，常累及脑膜，并引起不同程度的脑实质损害；多发生于儿童，其死亡率高，后遗症多，影响患儿自理能力；提高治愈率和减少后遗症是治疗乙脑的关键。我科自2006年始对乙脑后遗症行小脑顶核电刺激治疗辅以康复训练，取得很好的疗效，现报告如下。     

手部深部分枝杆菌感染的诊断与治疗

 目的 探讨手部深部慢性特殊感染的发病机制、治疗和预后。方法 复习15例手部深部慢性特殊感染病史的发病特点、特征和临床治疗结果。结果 15例患者经口服左氧氟沙星及阿奇霉素3个月后,痊愈7例,8例行手术治疗。治疗后手部功能TAM系统评定优12例,良2例,可1例。结论 联合应用喹诺酮类及大环内酯类药物化疗对大多数手部深部组织慢性特殊感染患者有效,可避免反复清创术导致的手术创伤。     

经颅低频聚焦超声联合微泡在开放血脑屏障中的研究进展

血脑屏障 (blood-brain barrier, BBB) 存在于血液与脑组织之间, 是一种特殊的保护性屏障.BBB的主要功能是选择性阻止大部分血液运载的溶质侵入中枢神经系统 (central nervous system, CNS) , 避免CNS受到损害, 从而有效维持着CNS内环境的稳定和正常的生理功能.但是在某些中枢神经系统疾病中, BBB也阻碍了大部分治疗性药物进入中枢神经系统, 影响了中枢神经系统疾病的有效治疗.因此, 如何安全、可逆地开放BBB成为近年来研究的重点.近年来研究表明, 低频聚焦超声联合微泡 (focused ultrasound-microbubbles therapy, FUS-MB) 能够瞬时、局部和可逆、无创地开放BBB, 开辟了颅内疾病的靶向给药治疗的新途径.对以FUS-MB技术打开BBB的研究进展及其机制予以综述.     

Management of mycoses in surgical patients -- review of the literature

Fungal infections have been recognized as major cause of morbidity and mortality in neutropenic and non-neutropenic surgical intensive care patients. The incidence of Candida has increased: it is now the fourth most often isolated pathogen in bloodstream infections. The incidence of Aspergillus infection in transplant patients is highest in heart and lung transplants: 19-26%. Most invasive fungal infections in surgical patients are caused by Candida spp. and Aspergillus spp., less by Cryptococcus spp. and may be classified as local or organ-related, as (chronic) disseminated, and as fungemia. There is no highly specific and sensitive routine test for the diagnosis of Candida and Aspergillus infections available; clinical signs of fungal infections are rather unspecific. The significance of colonization remains undetermined. In non-neutropenic surgical patients central venous access and broad-spectrum antibiotics are independent risk factors for the development of fungal infection. Immunsuppression, e.g., transplantation, burn injury, can render patients susceptible to fungal infection. This has lead to the introduction of antifungal prophylaxis in transplant and burned patients which has reduced the mortality for Candida spp. infection significantly. There is no prophylaxis available against Aspergillus spp. and Cryptococcus spp. Treatment of fungal infections consists of surgical and medical treatment for most organ-related infections. Recommendations for the management of fungal infections exist mostly for neutropenic patients, only few reports address the fungal infection of the surgical intensive care patient. Amphotericin B has been recommended as first line treatment for most severe fungal infections with fluconazole as follow-up treatment. In case of the development of toxic side effects of amphotericin B, mostly fluconazole or lipid formulations of amphotericin were favored. However, a shift in Candida strains towards non-albicans spp. and more resistant species was observed during recent years. This has lead to treatment failures in severe Candida and Aspergillus infections. The prognosis for invasive Aspergillus infections remains poor despite amphotericin B treatment. Newer azoles, e.g. voriconazole, demonstrated stable activity against most of these strains and may offer an option in the treatment of refractory fungal infections.     

Central nervous system pathology in children with aids

The neuropathology of AIDS in children shows striking differences to that in adults. Of special interest are the possible effects of HIV intrauterine infection on brain development, and on subsequent myelination. At present, it appears that CNS development in utero is normal, but post-natal myelination is delayed. AIDS encephalopathy and spinal cord pathology are the most frequently encountered CNS disorders and appear to be related to the presence of HIV within the nervous tissue. Opportunistic infections and lymphomas are related to immunosuppression and are less common. Other lesions of vascular or metabolic origin or possibly due to effects of therapy may also occur. Finally it must be emphasised that more than one pathological process may be responsible for symptoms and combinations of lesions may occur, e,g. AIDS encephalopathy combined with CNS lymphoma or CMV encephalitis, giving rise to complex or multiphasic neurological illness.     

欧洲儿科内分泌学会与欧洲内分泌学会《关于先天性甲状腺功能减退症的筛查、诊断和管理共识2020-2021年更新版》要点解读

先天性甲状腺功能减退症（CH）指出生时下丘脑-垂体-甲状腺轴功能障碍而导致的甲状腺激素产生不足或伴有轻微到严重的甲状腺激素缺乏症。据统计,新生儿CH患病率约为1/4 000,多数患儿出生时无明显异常表现,只有<10%的患儿可根据临床表现做出诊断。新生儿CH的典型临床表现包括头大、颈短、皮肤粗糙、面部黏液水肿、眼距宽等特殊面容及体态,常伴有智力发育迟缓、表情呆滞、神经反射迟钝等神经系统症状和嗜睡、食欲不振等生理功能低下等,如得不到及时治疗则可引起神经系统不可逆性损伤。多数CH患儿经早期治疗后生活质量与正常儿童无较大差异。本文主要对欧洲儿科内分泌学会与欧洲内分泌学会《关于CH的筛查、诊断和管理共识2020-2021年更新版》要点进行了解读,以促进CH临床诊治的规范化。     

98例耳部细菌感染患者病原菌分布及耐药分析

目的探讨耳部感染患者病原菌分布及其耐药情况。方法收集2010年1月1日至2011年12月31日海军总医院门诊和住院的98例耳部感染患者,采用K-B法进行病原菌药敏试验。结果占耳部细菌感染比例最高病原菌为凝固酶阴性葡萄球菌(CNS),其次为铜绿假单胞菌和大肠埃希菌。药敏结果显示,CNS对左旋氧氟沙星和庆大霉素有较低耐药率(5.9%和23.5%);铜绿假单胞菌和大肠埃希菌对阿米卡星和环丙沙星有较低耐药率(<37.5%)。结论耳部细菌感染常见病原菌为CNS、铜绿假单胞菌和大肠埃希菌,对喹诺酮类药物都有较低的耐药率,可以作为治疗耳部细菌感染的首选药物。     

医院外科术后感染的细菌分布及耐药性分析

目的了解我院外科术后感染病原菌的分布及耐药性.方法肉汤稀释法,应用英国先德微生物分析系统对本院外科感染标本进行细菌鉴定及药敏分析.结果肠杆菌属细菌为主要的创面感染菌,占总数的51.5%.环丙沙星、氨曲南、亚胺培南对肠杆菌科细菌呈现高度的敏感性;阳性珠菌感染26.3%,其中凝固酶阴性葡萄球菌(CNS)的感染明显增多,说明CNS已成为重要的机会致病菌.结论本组资料对外科术后感染的治疗和抗菌药物的选用具有一定的参考价值.     

Treatment of sexually transmitted chlamydial infections

Tetracycline hydrochloride, 500 mg orally four times a day for seven days, remains the treatment of choice for C trachomatis infections in men and nonpregnant women. Either erythromycin, 500 mg orally four times daily for seven days, or an equivalent dosage of another erythromycin product is an alternative treatment for patients who cannot tolerate tetracycline and for pregnant women. These two treatment regimens can be generalized to include nongonococcal urethritis and mucopurulent cervicitis. However, other treatment regimens that are effective against C trachomatis may not be effective for treating nongonococcal urethritis or mucopurulent cervicitis not caused by C trachomatis. The optimal treatment for pregnant women with C trachomatis infections and women with acute PID has not been established. Additional treatment trials with both groups of patients are needed to determine the effectiveness of antimicrobial agents in addition to those currently used, to establish the appropriate dose of each antimicrobial agent, and to clarify the appropriate duration of treatment. All individuals who are sexual partners of patients with nongonococcal urethritis, mucopurulent cervicitis, and acute PID (within the 30 days prior to onset of their symptoms or time of positive clinical evaluation findings) should be examined for sexually transmitted disease and treated promptly with a regimen effective against uncomplicated gonorrhea and chlamydial infections. Prompt treatment of sexual partners reduces the rate of treatment failure due to reinfection, reduces the transmission of infection, and reduces the frequency of occurrence of adverse sequelae of infection.     

中枢神经寄生虫感染

中枢神经感染寄生虫结果十分严重,早期诊断并治疗是降低死亡率重要手段,本综述介绍了中枢神经感染的线虫、绦虫、吸虫和原虫,其中线虫有广州管圆线虫（Angiostrongylus cantonensis）,旋毛线虫（Trichinella spiralis）,棘鄂口线虫（Gnathostoma spinigerum）,粪类圆线虫（Strogyloides stercoralis）和弓首蛔线虫属（Toxocara spp．）;绦虫有棘球绦虫属（Echinococcus spp．）,猪带绦虫（Taeniasolium）和迭宫绦虫属（Spirometra spp．）;吸虫有卫氏并殖吸虫（Paragonimus westermani）和血吸虫属（Schistosoma spp．）;原虫有克氏锥虫（Trypanosomacruzi）、布氏锥虫（Trypanosomabrucei）和福氏耐格阿米巴（Naegleriafcnvlerii）     

Febrile neutropenia in cancer patients in a tertiary care medical center in Lebanon: microbial spectrum and outcome

We prospectively analyzed the episodes of febrile neutropenia at the American University of Beirut Medical Center. One hundred and four episodes were studied in 64 patients over a period of 15 months: 81 (78%) with leukemia, 11 (10.5%) with lymphoma, 3 (2.8%) with multiple myeloma, and 9 (8.6%) with solid tumors. Bacteremia was confirmed in 30 episodes (29%), of which 18 (60%) were caused by gram-negative bacilli and 12 (40%) by gram-positive cocci. The predominant organisms were: E. coli (9), coagulase negative staphylococci (CNS) (6), Pseudomonas aeruginosa (5), and S. aureus (4). In seven episodes (6.7%) urinary tract infections were diagnosed, 6 with E. coli. Sputum cultures were positive in eight episodes (7%), 2 with P. aeruginosa, and 2 with methicillin resistant S. aureus. All patients were started empirically on antibacterial agents. In twenty-one episodes, a single antibiotic was started, ceftazidime being the most commonly used agent. In most cases, however, 2 or 3 antibacterial agents were started empirically. Antifungal therapy with amphotericin B (11) or fluconazole (20) was added because of persistent fever despite broad antibacterial coverage. Thirteen patients died (20%), 6 of them had bacteremia; 2 with gram-negative bacilli, and 4 with gram-positive cocci. Except for one, all patients had been started, at the onset of the fever, on antimicrobial agents to which the isolated microorganisms turned out to be susceptible. Our results show that infections with gram-negative bacteria continue to predominate unlike what has been reported recently from European and North American trials. A trend toward a higher mortality of infections caused by gram-positive cocci was noted.