Grandgirard Denis, Leib Stephen L
Institute for Infectious Diseases, University of Bern, Switzerland.
Curr Opin Pediatr. 2006 Apr;18(2):112-8. doi: 10.1097/01.mop.0000193292.09894.b7.
The mortality of bacterial meningitis can reach 30%, and up to 50% of survivors suffer from persisting neurological deficits as a consequence of the disease. The incidence of neurological sequelae of bacterial meningitis has not improved over the last decade. Adjunctive therapeutic options are limited, and ongoing research into the pathophysiology of brain damage in bacterial meningitis aims at providing the scientific basis for future development of more efficient adjunctive options.
In a population with good access to health care, dexamethasone given before or at the time of initiation of antibiotic therapy acts beneficially in paediatric pneumococcal meningitis, but not in meningococcal meningitis. In experimental animal models, brain-derived neurotrophic factor protected against brain injury and improved hearing while melatonin, which has antioxidant properties among other effects, reduced neuronal death. Transgene technology can be used to provide new insights into the pathophysiology of the disease and to identify potential therapeutic targets.
Although dexamethasone improves outcome of bacterial meningitis under defined circumstances, the morbidity of bacterial meningitis still remains unacceptably high. Experimental models may help to identify new therapeutic strategies to further improve the neurological outcome in young children suffering from bacterial meningitis.
细菌性脑膜炎的死亡率可达30%，高达50%的幸存者因该病而存在持续性神经功能缺损。细菌性脑膜炎神经后遗症的发生率在过去十年中并未改善。辅助治疗选择有限，目前对细菌性脑膜炎脑损伤病理生理学的研究旨在为未来开发更有效的辅助治疗方法提供科学依据。
在医疗保健可及性良好的人群中，在开始抗生素治疗之前或同时给予地塞米松对儿童肺炎球菌性脑膜炎有益，但对脑膜炎球菌性脑膜炎无效。在实验动物模型中，脑源性神经营养因子可预防脑损伤并改善听力，而褪黑素除其他作用外还具有抗氧化特性，可减少神经元死亡。转基因技术可用于深入了解该病的病理生理学并确定潜在的治疗靶点。
尽管地塞米松在特定情况下可改善细菌性脑膜炎的预后，但细菌性脑膜炎的发病率仍然高得令人无法接受。实验模型可能有助于确定新的治疗策略，以进一步改善患细菌性脑膜炎幼儿的神经学预后。
