¼±Åà - È­»ìǥŰ/¿£ÅÍŰ ´Ý±â - ESC

 

Meningitis 2001 Ãá°è Àü°øÀÇ ¿¬¼ö°­Á ¼º±Õ°üÀÇ´ë ¹é°æ¶õ

1. Bacterial meningitis°¡ ÀÇ½ÉµÉ ¶§ lumbar puncture¸¦ ¸ÕÀú ÇÒ °ÍÀΰ¡, ¾Æ´Ï¸é BRCT¸¦

¸ÕÀú ÂïÀ» °ÍÀΰ¡?

1) BRCT ÀÌ»ó °¡´É¼ºÀÌ ³ôÀº °æ¿ì:

(altered mental status, papilledema, focal neurologic signs, 60¼¼ÀÌ»ó,

immunocompromised pt, CNS ds Hx, recent seizures)

blood culture, empirical antibioticsÅõ¿©ÈÄ BRCT check

-> ±×´ÙÀ½ lumbar puncture

2) BRCT ÀÌ»ó °¡´É¼ºÀÌ ³·Àº °æ¿ì

Áï½Ã lumbar puncture & CSF analysis

empirical antibiotics

* lumbar puncture 1-2½Ã°£ Àü¿¡ Ç×»ýÁ¦¸¦ Åõ¿©ÇÑ´Ù°í ÇØ¼­ Áø´Ü¿¡ ÁöÀåÀ» ÃÊ·¡ÇÏÁö ¾Ê´Â´Ù.

2. Bacterial meningitisÀÇ ¿øÀαÕ(¼ºÀο¡¼­)

S. pneumoniae, N. meningitidis, L. monocytogenes, GNB

3. ¿ì¸®³ª¶ó¿¡¼­ bacterial meningitis¶§ °æÇèÀû Ç×»ýÁ¦ Ä¡·á

¿ì¸®³ª¶ó¿¡´Â penicillin-resistant, multi-drug resistant S. pneumoniae°¡ °¢°¢ 70%, 20%·Î

³ôÀ¸¹Ç·Î óÀ½ ½ÃÀÛÇÏ´Â °æÇèÀû Ç×»ýÁ¦´Â

: ceftriaxone + vancomycin (¡¾rifampin)

+- ceftriaxone 2.0g IV q 12hr

| vancomycin 2.0 IV q 12hr

+- rifampin 600 mg PO

* Ä¡·á½ÃÀÛÈÄ 24-36½Ã°£ÈÄ¿¡ repeat CSF analysis¸¦ ½ÃÇàÇØ¾ß ÇÑ´Ù.

4. S. pneumoniae¿¡ ÀÇÇÑ bacterial meningitis¶§ susceptibility test½ÃÇà

penicillin ceftriaxone

MIC(ug/mL) <0.1 <0.5 => penicillin ´Üµ¶Ä¡·á

>0.1 <0.5 => ceftrixone ´Üµ¶Ä¡·á

>0.1 >0.5 => ceftriaxone + vancomycin or rifampin

5. bacterial meningitis Ä¡·á±â°£

H. influenza, N. meningitidis: 1ÁÖ

S. pneumoniae : 2ÁÖ

L. monocytogenes: 2-3ÁÖ

GNB: 3ÁÖ

6. Tuberculous meningitis Ä¡·á±â°£: ¾àÁ¦´Â pul. tuberculosis¿¡ ÁØÇÑ´Ù.

INH, rifampin susceptible : 9°³¿ù

INH resistant: 12°³¿ù

RFP resistant: 18-24°³¿ù

7. Tuberculous meningitis¿¡¼­ HERZ Åõ¿©ÈÄ Áõ»óÀÌ È£ÀüµÇ´Ù°¡ ´Ù½Ã ¹ß¿­°ú µÎÅëÀÌ

¾ÇÈ­µÉ ¶§ CSF¿¡¼­ polymorphonuclear pleocytosis°¡ ³ªÅ¸³µ´Ù¸é? Ä¡·á¸¦ ±×´ë·Î

Áö¼ÓÇÑ´Ù.

Tbc meningitisÄ¡·áÁß¿¡ ÀÓ»óÀûÀ¸·Î ¾ÇÈ­µÇ´Â ¼ö°¡ ¸¹Àºµ¥ ¿øÀÎÀº Àß ¸ð¸£Áö¸¸ PML

pleocytosis ´Â ÀϽÃÀûÀ̰í ÀúÀý·Î ȸº¹µÈ´Ù. bacterial meningitis°¡ superimposeµÈ °ÍÀº

¾Æ´Ï´Ù.