Deigendesch Nikolaus, Stenzel Werner
Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Neuropathology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Handb Clin Neurol. 2017;145:217-226. doi: 10.1016/B978-0-12-802395-2.00016-X.
Pathogen-induced inflammatory diseases mostly involving, but sometimes exclusively affecting, the central nervous system (CNS) manifest with a plethora of signs and symptoms. The different diseases are still difficult to cure despite modern diagnostic, preventive, and therapeutic advances, and this is mainly due to the host inflammatory response, leading to irreversible tissue damage. Knowledge about underlying pathomechanisms is constantly growing, and numerous studies on humans, human material, and animal models as well as in vitro systems have considerably increased our understanding of molecular mechanisms; however, there are still enormous uncertainties with respect to host-pathogen interaction and treatment. There are important regional variations as to prevalence and susceptibility of diseases, reflecting the importance of environmental factors, and immunogenetic peculiarities of different ethnicities. In addition, the opportunistic infections of the CNS are becoming very relevant, not only in the context of human immunodeficiency virus (HIV), but also in the context of modern, highly specific immunosuppressive or immunomodulatory treatments, evoking new and unmet diagnostic and therapeutic challenges. This chapter summarizes up-to-date knowledge about bacterial CNS infections, as well as cerebral sarcoidosis, focussing on morphologic aspects.
病原体诱导的炎症性疾病大多累及但有时仅影响中枢神经系统（CNS），表现出大量的体征和症状。尽管现代诊断、预防和治疗取得了进展，但不同的疾病仍然难以治愈，这主要是由于宿主的炎症反应导致不可逆的组织损伤。关于潜在发病机制的知识不断增加，大量针对人类、人体材料、动物模型以及体外系统的研究极大地增进了我们对分子机制的理解；然而，在宿主与病原体的相互作用及治疗方面仍存在巨大的不确定性。疾病的患病率和易感性存在重要的区域差异，这反映了环境因素以及不同种族免疫遗传学特性的重要性。此外，中枢神经系统的机会性感染正变得非常重要，不仅在人类免疫缺陷病毒（HIV）的背景下如此，在现代高度特异性免疫抑制或免疫调节治疗的背景下也是如此，这引发了新的、尚未满足的诊断和治疗挑战。本章总结了关于细菌性中枢神经系统感染以及脑结节病的最新知识，重点关注形态学方面。
