Tunkel A R, Wispelwey B, Scheld W M
University of Virginia School of Medicine, Charlottesville.
Ann Intern Med. 1990 Apr 15;112(8):610-23. doi: 10.7326/0003-4819-112-8-610.
To review recent advances in the understanding of pathogenic and pathophysiologic mechanisms underlying bacterial meningitis that may lead to the development of adjunctive strategies for treating this disorder.
Studies published from 1975 to 1989 were identified using Index Medicus and by reviewing the bibliographies of identified articles.
We reviewed the experimental and human studies evaluating pathogenesis, pathophysiology, and antimicrobial treatment of bacterial meningitis, as well as those reviews that have contributed to our understanding of meningitis.
We evaluated the data on the pathogenesis, pathophysiology, and treatment of bacterial meningitis and considered in depth the information from animal models that may have potentially important applications in the treatment of human disease.
Penicillin and ampicillin remain the drugs of choice for meningitis caused by Streptococcus pneumoniae and Neisseria meningitidis. The third-generation cephalosporins have revolutionized the treatment of gram-negative bacillary meningitis; one such agent, ceftazidime, is also useful for treating Pseudomonas aeruginosa meningitis. Modification of subarachnoid space inflammation by anti-inflammatory agents may lessen many of the pathophysiologic consequences of bacterial meningitis. A recent study of adjunctive dexamethasone therapy in infants and children with bacterial meningitis showed that the incidence of long-term neurologic sequelae was lower in the corticosteroid group.
Future therapy for bacterial meningitis will use recent developments in the understanding of pathogenic and pathophysiologic mechanisms underlying this disease. Additional studies using monoclonal antibodies against specific virulence factors and investigations into the production of inflammatory cytokines in response to bacterial cell products may lead to additional treatments that decrease the high morbidity and mortality in patients with bacterial meningitis.
综述对细菌性脑膜炎致病及病理生理机制理解的最新进展，这些进展可能会促成治疗该疾病辅助策略的发展。
使用《医学索引》并通过查阅已识别文章的参考文献，识别1975年至1989年发表的研究。
我们回顾了评估细菌性脑膜炎发病机制、病理生理学及抗菌治疗的实验研究和人体研究，以及有助于我们理解脑膜炎的综述。
我们评估了细菌性脑膜炎发病机制、病理生理学及治疗方面的数据，并深入考虑了来自动物模型的信息，这些信息可能在人类疾病治疗中具有潜在的重要应用。
青霉素和氨苄西林仍然是肺炎链球菌和脑膜炎奈瑟菌所致脑膜炎的首选药物。第三代头孢菌素彻底改变了革兰阴性杆菌性脑膜炎的治疗；其中一种药物头孢他啶，也可用于治疗铜绿假单胞菌脑膜炎。抗炎药物对蛛网膜下腔炎症的调节可能会减轻细菌性脑膜炎的许多病理生理后果。最近一项针对患细菌性脑膜炎婴幼儿的辅助地塞米松治疗研究表明，皮质类固醇组长期神经后遗症的发生率较低。
细菌性脑膜炎的未来治疗将利用对该疾病致病及病理生理机制理解的最新进展。使用针对特定毒力因子的单克隆抗体的进一步研究，以及对细菌细胞产物引发的炎性细胞因子产生情况的调查，可能会带来更多降低细菌性脑膜炎患者高发病率和死亡率的治疗方法。
