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細菌性髄膜炎診断と治療の流れ

細菌性髄膜炎を疑った場合音診断と治療の流れをフローチャート化している。
 
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画像2:[ID0601]
出典
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1: Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis. 2004 Nov 1;39(9):1267-84. doi: 10.1086/425368. Epub 2004 Oct 6.

細菌性髄膜炎におけるグラム染色に応じた初期治療

各グラム染色に対応した原因菌に応じて選択すべき抗菌薬。代表的な細菌性髄膜炎の原因菌に対する選択すべき治療薬と代替案を示している。
 
参考文献
  1. Basmaci R, Bonacorsi S, Bidet P, et al.: Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France. Clin Infect Dis. 2015 Sep 1;61(5):779-86. PMID: 25944342.
出典
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1: 著者提供

細菌性髄膜炎の経験的治療

各年齢やリスク、病態別の代表的原因菌と推奨薬を示している。
 
参考文献:
2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clinical Infectious Diseases 2017;64(6):e34–e65
出典
imgimg
1: Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis. 2004 Nov 1;39(9):1267-84. doi: 10.1086/425368. Epub 2004 Oct 6.

細菌性髄膜炎治療の推奨抗菌薬投与量

細菌性髄膜炎の治療に推奨される標準的な抗菌薬の投与量を示した。
 
参考文献:
2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clinical Infectious Diseases 2017;64(6):e34–e65
出典
imgimg
1: Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis. 2004 Nov 1;39(9):1267-84. doi: 10.1086/425368. Epub 2004 Oct 6.

細菌性髄膜炎の標的治療

各原因菌の感受性に準じた標準治療薬と代替薬を示している。表を参考にして経験治療から変更を行う。
 
参考文献:
2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clinical Infectious Diseases 2017;64(6):e34–e65
出典
imgimg
1: Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis. 2004 Nov 1;39(9):1267-84. doi: 10.1086/425368. Epub 2004 Oct 6.

ライム病

流行地[マップ]におけるマダニ(Ixodes)への曝露歴から想起する。
出典
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1: GIS and Remote Sensing Use in the Exploration of Lyme Disease Epidemiology.
著者: Esra Ozdenerol
雑誌名: Int J Environ Res Public Health. 2015 Dec 1;12(12):15182-203. doi: 10.3390/ijerph121214971. Epub 2015 Dec 1.
Abstract/Text: Given the relatively recent recognition of Lyme disease (LD) by CDC in 1990 as a nationally notifiable infectious condition, the rise of reported human cases every year argues for a better understanding of its geographic scope. The aim of this inquiry was to explore research conducted on spatiotemporal patterns of Lyme disease in order to identify strategies for implementing vector and reservoir-targeted interventions. The focus of this review is on the use of GIS-based methods to study populations of the reservoir hosts, vectors and humans in addition to the spatiotemporal interactions between these populations. New GIS-based studies are monitoring occurrence at the macro-level, and helping pinpoint areas of occurrence at the micro-level, where spread within populations of reservoir hosts, clusters of infected ticks and tick to human transmission may be better understood.
Int J Environ Res Public Health. 2015 Dec 1;12(12):15182-203. doi: 10....

髄腔内注入に用いられる抗菌薬

髄腔内投与の経験が多いものはバンコマイシン、アミノグリコシド系抗菌薬(ゲンタマイシン、アミカシン、トブラシン)であり、その他の薬剤の髄腔内投与には慎重な判断を要する。なお、全て適応外使用の方法となる点に留意する。
出典
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1: 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis.
著者: Allan R Tunkel, Rodrigo Hasbun, Adarsh Bhimraj, Karin Byers, Sheldon L Kaplan, W Michael Scheld, Diederik van de Beek, Thomas P Bleck, Hugh J L Garton, Joseph R Zunt
雑誌名: Clin Infect Dis. 2017 Feb 14;. doi: 10.1093/cid/ciw861. Epub 2017 Feb 14.
Abstract/Text: The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
Clin Infect Dis. 2017 Feb 14;. doi: 10.1093/cid/ciw861. Epub 2017 Feb ...

過去に報告された細菌性髄膜炎の診断アルゴリズム

参考文献:
[1] Boyer D, Gordon RC, Baker T. Lack of clinical usefulness of a positive latex agglutination test for Neisseria meningitidis/Escherichia coli antigens in the urine. Pediatr Infect Dis J. 1993 Sep;12(9):779-80. PubMed PMID: 8414808.
[2] Oostenbrink R, Moons KG, Donders AR, Grobbee DE, Moll HA. Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures. Acta Paediatr. 2001 Jun;90(6):611-7. PubMed PMID: 11440091.
[3] Nigrovic LE, Kuppermann N, Malley R. Development and validation of a multivariable predictive model to distinguish bacterial from aseptic meningitis in children in the post-Haemophilus influenzae era. Pediatrics. 2002 Oct;110(4):712-9. PubMed PMID: 12359784.
[4] Bonsu BK, Harper MB. Differentiating acute bacterial meningitis from acute viral meningitis among children with cerebrospinal fluid pleocytosis: a multivariable regression model. Pediatr Infect Dis J. 2004 Jun;23(6):511-7. PubMed PMID: 15194831.
[5] Hoen B, Viel JF, Paquot C, Gérard A, Canton P. Multivariate approach to differential diagnosis of acute meningitis. Eur J Clin Microbiol Infect Dis. 1995 Apr;14(4):267-74. PubMed PMID: 7649188.
[6] Freedman SB, Marrocco A, Pirie J, Dick PT. Predictors of bacterial meningitis in the era after Haemophilus influenzae. Arch Pediatr Adolesc Med. 2001 Dec;155(12):1301-6. PubMed PMID: 11732947.
[7] Chavanet P, Schaller C, Levy C, Flores-Cordero J, Arens M, Piroth L, Bingen E, Portier H. Performance of a predictive rule to distinguish bacterial and viral meningitis. J Infect. 2007 Apr;54(4):328-36. Epub 2006 Aug 2. PubMed PMID:16887191.
[8] Spanos A, Harrell FE Jr, Durack DT. Differential diagnosis of acute meningitis. An analysis of the predictive value of initial observations. JAMA.1989 Nov 17;262(19):2700-7. PubMed PMID: 2810603.
[9] Tokuda Y, Koizumi M, Stein GH, Birrer RB. Identifying low-risk patients for bacterial meningitis in adult patients with acute meningitis. Intern Med. 2009;48(7):537-43. Epub 2009 Apr 1. PubMed PMID: 19336955.
[10] De Cauwer HG, Eykens L, Hellinckx J, Mortelmans LJ. Differential diagnosis between viral and bacterial meningitis in children. Eur J Emerg Med. 2007 Dec;14(6):343-7. PubMed PMID: 17968200.
[11] Schmidt H, Heimann B, Djukic M, Mazurek C, Fels C, Wallesch CW, Nau R. Neuropsychological sequelae of bacterial and viral meningitis. Brain. 2006 Feb;129(Pt 2):333-45. Epub 2005 Dec 19. PubMed PMID: 16364957.
引用:van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, Leib SL, Mourvillier B, Ostergaard C, Pagliano P, Pfister HW, Read RC, Sipahi OR, Brouwer MC; ESCMID Study Group for Infections of the Brain (ESGIB). ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect.2016 May;22 Suppl 3:S37-62. doi: 10.1016/j.cmi.2016.01.007. Epub 2016 Apr 7.PubMed PMID: 27062097.(改変有)
出典
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1: ESCMID guideline: diagnosis and treatment of acute bacterial meningitis.
Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. doi: 10.1016/j.cmi.2016.01.007. Epub 2016 Apr 7.

予防内服の適応とレジメ

参考文献:
Larry K. M.d. Pickering, Carol J., M.D. Baker, David W., M.D. Kimberlin, Sarah S., M.D. Long:Red Book, 2012 Report of the Committee on Infectious Diseases (Red Book Report of the Committee on Infectious Diseases), 347-348;Table 3.9. and 503-504;Table 3.36,3.37.
出典
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1: 著者提供

細菌性髄膜炎診断と治療の流れ

細菌性髄膜炎を疑った場合音診断と治療の流れをフローチャート化している。
 
画像1:[ID0602]
画像2:[ID0601]
出典
imgimg
1: Practice guidelines for the management of bacterial meningitis.
Clin Infect Dis. 2004 Nov 1;39(9):1267-84. doi: 10.1086/425368. Epub 2004 Oct 6.

細菌性髄膜炎におけるグラム染色に応じた初期治療

各グラム染色に対応した原因菌に応じて選択すべき抗菌薬。代表的な細菌性髄膜炎の原因菌に対する選択すべき治療薬と代替案を示している。
 
参考文献
  1. Basmaci R, Bonacorsi S, Bidet P, et al.: Escherichia Coli Meningitis Features in 325 Children From 2001 to 2013 in France. Clin Infect Dis. 2015 Sep 1;61(5):779-86. PMID: 25944342.
出典
img
1: 著者提供