Scarborough Matthew, Thwaites Guy E
Nuffield Department of Clinical Laboratory Science, John Radcliffe Hospital, Oxford, UK.
Lancet Neurol. 2008 Jul;7(7):637-48. doi: 10.1016/S1474-4422(08)70139-X.
Acute bacterial meningitis is more common in resource-poor than resource-rich settings. Survival is dependent on rapid diagnosis and early treatment, both of which are difficult to achieve when laboratory support and antibiotics are scarce. Diagnostic algorithms that use basic clinic and laboratory features to distinguish bacterial meningitis from other diseases can be useful. Analysis of the CSF is essential, and simple techniques can enhance the yield of diagnostic microbiology. Penicillin-resistant and chloramphenicol-resistant bacteria are a considerable threat in resource-poor settings that go undetected if CSF and blood can not be cultured. Generic formulations of ceftriaxone are becoming more affordable and available, and are effective against meningitis caused by penicillin-resistant or chloramphenicol-resistant bacteria. However, infection with Streptococcus pneumoniae with reduced susceptibility to ceftriaxone is reported increasingly, and alternatives are either too expensive (eg, vancomycin) or can not be widely recommended (eg, rifampicin, which is the key drug to treat tuberculosis) in resource-poor settings. Additionally, improved access to affordable antibiotics will not overcome the problems of poor access to hospitals and the fatal consequences of delayed treatment. The future rests with the provision of effective conjugate vaccines against S pneumoniae, Haemophilus influenzae, and Neisseria meningitides to children in the poorest regions of the world.
急性细菌性脑膜炎在资源匮乏地区比资源丰富地区更为常见。生存取决于快速诊断和早期治疗，而当实验室支持和抗生素稀缺时，这两者都难以实现。利用基本临床和实验室特征将细菌性脑膜炎与其他疾病区分开来的诊断算法可能会有所帮助。脑脊液分析至关重要，简单的技术可以提高诊断微生物学的检出率。耐青霉素和耐氯霉素的细菌在资源匮乏地区构成相当大的威胁，如果脑脊液和血液无法培养，这些威胁就会被忽视。头孢曲松的通用制剂正变得越来越实惠且容易获得，并且对耐青霉素或耐氯霉素细菌引起的脑膜炎有效。然而，对头孢曲松敏感性降低的肺炎链球菌感染报告越来越多，在资源匮乏地区，替代药物要么太贵（如万古霉素），要么不能广泛推荐（如利福平，它是治疗结核病的关键药物）。此外，增加获得负担得起的抗生素的机会并不能克服就医困难以及治疗延迟带来的致命后果这两个问题。未来取决于为世界最贫困地区的儿童提供针对肺炎链球菌、流感嗜血杆菌和脑膜炎奈瑟菌的有效结合疫苗。
