Roos Karen L, van de Beek Diederik
Department of Neurology, Indiana University School of Medicine, Indiana University Hospital, Indianapolis, 46202, USA.
Handb Clin Neurol. 2010;96:51-63. doi: 10.1016/S0072-9752(09)96004-3. Epub 2010 Jan 19.
Bacterial meningitis is a neurological emergency. Empiric antimicrobial and adjunctive therapy should be initiated as soon as a single set of blood cultures has been obtained. Clinical signs suggestive of bacterial meningitis include fever, headache, meningismus, vomiting, photophobia, and an altered level of consciousness. The peripheral white blood cell count with a left shift, an elevated serum procalcitonin and C-reactive protein, and a cerebrospinal fluid pleocytosis with a predominance of polymorphonuclear leukocytes, and a decreased glucose concentration are predictive of bacterial meningitis. Patients with documented bacterial meningitis and those in whom the diagnosis is a strong possibility should be admitted to the intensive care unit. Timely recognition of bacterial meningitis and initiation of therapy are critical to outcome.
细菌性脑膜炎是一种神经系统急症。一旦获取了一组血培养样本，就应立即开始经验性抗菌治疗和辅助治疗。提示细菌性脑膜炎的临床体征包括发热、头痛、颈项强直、呕吐、畏光及意识水平改变。外周血白细胞计数左移、血清降钙素原和C反应蛋白升高、脑脊液细胞增多且以多形核白细胞为主以及葡萄糖浓度降低，这些都提示细菌性脑膜炎。确诊为细菌性脑膜炎的患者以及极有可能诊断为此病的患者应收入重症监护病房。及时识别细菌性脑膜炎并开始治疗对预后至关重要。
