Heym B, Schindera F, Ringelmann R
Institut für Medizinische Mikrobiologie und Immunologie, Städtisches Klinikum Karlsruhe, Akademisches Lehrkrankenhaus der Universität Freiburg.
Immun Infekt. 1987 Sep;15(5):179-85.
The diagnosis on the exclusion of infectious diseases of the central nervous system, especially of bacterial infections still is one of the most important issues in clinical microbiology. In bacterial meningitis, where lethal courses as well as severe sequelae are still frequent, there should be a rapid diagnosis not only with microscopy but also with Limulus test and antigen detection tests because a specific therapy should be initiated as soon as possible. But also viral infections caused by varicella or herpes virus are increasingly susceptible to chemotherapy. The indication for the examination of cerebrospinal fluid, the minimal volume for exhaustive laboratory tests and the possibilities of a stepwise diagnostic procedure are given with reference data from literature for the various techniques. In our experience the synopsis of laboratory results and clinical symptoms yielded in 75% of all cases the exclusion of an infectious etiology of the disease. In 17% a bacterial meningitis or the infection of a hydrocephalus shunt could be diagnosed. Viral infections could be proven in 4% either by antibody or by antigen detection. Only in 1% of all patients the clinical symptoms and the laboratory parameters remained unclear.
排除中枢神经系统传染病，尤其是细菌感染的诊断，仍然是临床微生物学中最重要的问题之一。在细菌性脑膜炎中，致死病程以及严重后遗症仍然很常见，不仅应通过显微镜检查，还应通过鲎试剂检测和抗原检测试验进行快速诊断，因为应尽快开始特异性治疗。但水痘或疱疹病毒引起的病毒感染也越来越容易受到化疗的影响。参考文献中各种技术的相关数据，给出了脑脊液检查的指征、详尽实验室检测的最小体积以及逐步诊断程序的可能性。根据我们的经验，75%的病例通过实验室结果和临床症状的综合分析排除了疾病的感染病因。17%的病例可诊断为细菌性脑膜炎或脑积水分流感染。4%的病例通过抗体或抗原检测证实为病毒感染。在所有患者中，只有1%的临床症状和实验室参数仍不明确。
