Friedl A, Schaad H J, Sturzenegger M, Caversaccio M
Departement Innere Medizin, Inselspital Bern.
Praxis (Bern 1994). 1998 Jun 10;87(24):839-44.
We present three patients with otogenic meningitis, whose illness varied in extent and clinical course. Meningitis and otitis media are associated in 19-22% of all meningitis-patients. Streptococcus pneumoniae is the predominant microorganism with hemophilus influenzae being the second most important. We discuss the importance and problems of spinal puncture, early CT-scan as well as further, more extensive and sophisticated examinations to exclude late complications or predisposing factors. We emphasize an early start of antibiotic treatment, which should not be delayed for diagnostic reasons. With the appearance of highly penicillin-resistant pneumococci antibiotic therapy may become more difficult in the future, but for the moment pneumococcal infections in Switzerland can initially still be treated with cephalosporins or high dose penicillin. The use of steroids, although of unproven efficacy, may be considered in some cases. An otolaryngologist should initially be consulted for diagnostic reasons as well as for possibly indicated early surgery.
我们报告了三名耳源性脑膜炎患者，其病情严重程度和临床病程各不相同。在所有脑膜炎患者中，19%至22%的病例与脑膜炎和中耳炎有关。肺炎链球菌是主要的微生物，流感嗜血杆菌是第二重要的微生物。我们讨论了腰椎穿刺、早期CT扫描以及进一步更广泛、更复杂检查以排除晚期并发症或易感因素的重要性和问题。我们强调应尽早开始抗生素治疗，不应因诊断原因而延迟。随着高度耐青霉素肺炎球菌的出现，未来抗生素治疗可能会变得更加困难，但目前在瑞士，肺炎球菌感染最初仍可用头孢菌素或大剂量青霉素治疗。在某些情况下，尽管类固醇的疗效尚未得到证实，但仍可考虑使用。出于诊断原因以及可能需要的早期手术，最初应咨询耳鼻喉科医生。
