小结
定义
病史和体格检查
关键诊断因素
- 头痛
- 颈项强直
- 发热
- 精神状态改变
- 呕吐
- 意识模糊
- 畏光
- 癫痫发作
- 存在的危险因素
其他诊断因素
- 局灶性神经系统体征
- 眼球运动异常
- 面神经麻痹
- 平衡问题/听力障碍
- 皮疹
- 视神经乳头水肿
- 克尼格氏征
- 布鲁津斯基征
危险因素
- 高龄
- 拥挤
- 接触致病菌
- 导致免疫功能低下的疾病
- 颅骨结构缺陷/脑室-腹腔分流术
- 耳蜗植入物
- 镰状细胞病
- 邻近部位感染
- 遗传易感性
诊断性检查
首要检查
- 血培养
- 血清肺炎球菌和脑膜炎球菌 PCR
- 血糖
- FBC 和分类计数
- 血清尿素、肌酐和电解质
- 静脉血气
- 肝功能检查 (LFT)
- 凝血筛查（凝血酶原时间、INR、活化 PTT、纤维蛋白原、纤维蛋白降解产物）
- 血清 HIV
- 血清降钙素原（procalcitonin, PCT）
- 血清 CRP（如果无法进行 PCT）
- 脑脊液（Cerebrospinal Fluid, CSF）蛋白
- 脑脊液乳酸
- CSF 葡萄糖
- CSF 显微镜检查、革兰染色、培养和药敏试验
- 脑脊液细胞计数
- 肺炎球菌 CSF 聚合酶链反应（polymerase chain reaction, PCR）
需考虑的检查
- 神经影像
- 应用 CSF PCR 检测结核病
- 通过 CSF PCR 检测 1 型和 2 型单纯疱疹病毒（herpes simplex virus, HSV）以及水痘带状疱疹病毒。
- 采集 CSF、粪便和咽拭子进行肠道病毒 PCR
治疗流程
疑似细菌性脑膜炎：医院就诊
疑似细菌性脑膜炎：社区就诊
确诊细菌性脑膜炎：流感嗜血杆菌
确诊细菌性脑膜炎：肠杆菌科细菌
确诊细菌性脑膜炎：肺炎链球菌
确诊细菌性脑膜炎：单核细胞增生李斯特菌
确诊细菌性脑膜炎：金黄色葡萄球菌
确诊细菌性脑膜炎：结核杆菌
确诊细菌性脑膜炎：脑膜炎奈瑟菌
未确诊但临床怀疑细菌性脑膜炎
撰稿人
专家顾问
Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd
Emergency Medicine Consultant
Barts Health NHS Trust
Physician Response Unit Consultant
London’s Air Ambulance
Royal London Hospital
London
UK
利益声明
AA declares that he has no competing interests.
Annie Chapman, MBChB, BSc
ST4 Emergency Medicine Doctor
Royal London Hospital
Physician Response Unit Clinical Fellow
London
UK
利益声明
AC declares that she has no competing interests.
鸣谢
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:
A. Marceline Tutu van Furth, MD, PhD, MBA
Professor in Pediatric Infectious Diseases
Vrije Universiteit Medical Center
Amsterdam
The Netherlands
Disclosures: AMTvF declares that she has no competing interests.
Omaima El Tahir, MD
PhD Candidate
Pediatric Infectious Diseases and Immunogenetics
Vrije Universiteit Medical Center
Amsterdam
The Netherlands
Disclosures: OET declares that she has no competing interests.
同行评议者
Robert Taylor, MBChB, MRCP(UK), MRCP(London), DipMedTox, DipTher PGDME, FHEA FRCEM
Acute Hospital Sub Dean (Cornwall)
Honorary Clinical Senior Lecturer
Consultant Emergency Physician
The Knowledge Spa
Royal Cornwall Hospital
Truro
UK
利益声明
RT declares that he has no competing interests.
编辑
Celia Pincus
Section Editor, BMJ Best Practice
利益声明
CP declares that she has no competing interests.
Anna Ellis
Head of Editorial, BMJ Best Practice
利益声明
AE declares that she has no competing interests.
Rachel Wheeler
Lead Section Editor, BMJ Best Practice
利益声明
RW declares that she has no competing interests.
Julie Costello
Comorbidities Editor, BMJ Best Practice
利益声明
JC declares that she has no competing interests.
Irene Chiwele
Drug Editor, BMJ Best Practice
利益声明
IC declares that she has no competing interests.
Adam Mitchell
Drug Editor, BMJ Best Practice
利益声明
AM declares that he has no competing interests.
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