围脑膜感染识别和诊断的重要性

Importance of recognition and diagnosis of perimeningeal infection

摘要:

随着抗生素的广泛应用和不断更新，感染性疾病对人类健康的威胁已经得到卓有成效的控制。在二代测序、药敏试验等辅助检查手段的支持下，临床医生在多数情况下可以精确地找到责任病原体并拟定相应的治疗方案。中枢神经系统由于其特殊的解剖生理特点，一直是危重或难治性感染的好发部位。其中好发于硬脑膜及其周围结构的围脑膜感染，因其特殊的病因学及病理生理机制，成为诸多中枢神经系统感染性疾病中与外周感染联系最为紧密的一类。虽然围脑膜感染多有较典型的前驱感染，但由于其起病隐匿、症状缺乏特异性，容易被前驱感染的表现所掩盖。而一旦进入显症期则意味着中枢神经系统损害可能已经产生，且单纯的药物治疗往往无法有效控制感染。因此，临床医生早期识别和诊断围脑膜感染并及时给予相应的抗菌治疗是当下避免该类可治性神经系统疾病造成不良预后的重要方式，同时也可减少不必要的外科干预对机体的损害。

Abstract:

With the development of antibiotics, the threat generated by infectious diseases has been successfully relieved. Clinicians could lock the criminal pathogen and apply corresponding treatment under the help of current testing methods like NGS and drug sensitive test. The central nervous system has been one of the commonest sites where intensive or refractory infections occur due to its special anatomic and physiologic characters. Among all the CNS infections, the perimeningeal infections which happens to or around the dura are thought to related with peripheral infections most closely as for their special etiology and pathophysiology. Although perimeningeal infections are usually caused by some anteceded infections, but their insidious course and unspecific manifestations make them hard to be diagnosed in time. Once perimeningeal infections begin to show apparent symptoms, serious damage could have been done to the CNS, which could not be cured by simple antibiotic therapies. Therefore, early recognition and diagnosis of perimeningeal infections with corresponding antibacterial treatment is the most important way to avoid poor prognosis caused by these curable neurological disorders, and at the same time, it can reduce the damage of unnecessary surgical intervention to the body.