Francis Crick Institute.
NIHR Mucosal Pathogens Research Unit, Department of Infection, Division of Infection and Immunity, University College London, London, UK.
Curr Opin Neurol. 2021 Jun 1;34(3):386-395. doi: 10.1097/WCO.0000000000000934.
Community-acquired bacterial meningitis is a continually changing disease. This review summarises both dynamic epidemiology and emerging data on pathogenesis. Updated clinical guidelines are discussed, new agents undergoing clinical trials intended to reduce secondary brain damage are presented.
Conjugate vaccines are effective against serotype/serogroup-specific meningitis but vaccine escape variants are rising in prevalence. Meningitis occurs when bacteria evade mucosal and circulating immune responses and invade the brain: directly, or across the blood-brain barrier. Tissue damage is caused when host genetic susceptibility is exploited by bacterial virulence. The classical clinical triad of fever, neck stiffness and headache has poor diagnostic sensitivity, all guidelines reflect the necessity for a low index of suspicion and early Lumbar puncture. Unnecessary cranial imaging causes diagnostic delays. cerebrospinal fluid (CSF) culture and PCR are diagnostic, direct next-generation sequencing of CSF may revolutionise diagnostics. Administration of early antibiotics is essential to improve survival. Dexamethasone partially mitigates central nervous system inflammation in high-income settings. New agents in clinical trials include C5 inhibitors and daptomycin, data are expected in 2025.
Clinicians must remain vigilant for bacterial meningitis. Constantly changing epidemiology and emerging pathogenesis data are increasing the understanding of meningitis. Prospects for better treatments are forthcoming.
社区获得性细菌性脑膜炎是一种不断变化的疾病。本文总结了该病动态流行病学和发病机制方面的新数据。讨论了最新的临床指南，介绍了正在进行临床试验的旨在减少继发性脑损伤的新药。
结合疫苗对特定血清型/血清群脑膜炎有效，但疫苗逃逸变体的流行率正在上升。当细菌逃避黏膜和循环免疫反应并侵入大脑时，就会发生脑膜炎：直接侵入或通过血脑屏障侵入。当宿主遗传易感性被细菌毒力利用时，就会导致组织损伤。经典的三联征（发热、颈部僵硬和头痛）的诊断敏感性较差，所有指南都反映出需要高度怀疑和早期腰椎穿刺。不必要的颅成像会导致诊断延迟。脑脊液（CSF）培养和 PCR 具有诊断价值，CSF 的直接下一代测序可能会彻底改变诊断。早期使用抗生素至关重要，以提高生存率。地塞米松在高收入地区部分减轻中枢神经系统炎症。临床试验中的新药包括 C5 抑制剂和达托霉素，预计将于 2025 年获得数据。
临床医生必须对细菌性脑膜炎保持警惕。不断变化的流行病学和新出现的发病机制数据增加了对脑膜炎的认识。更好的治疗方法即将出现。
