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
¾Ç鵃 ¶§ CSF¿¡¼ polymorphonuclear pleocytosis°¡ ³ªÅ¸³µ´Ù¸é? Ä¡·á¸¦ ±×´ë·Î
Áö¼ÓÇÑ´Ù.
Tbc meningitisÄ¡·áÁß¿¡ ÀÓ»óÀûÀ¸·Î ¾ÇȵǴ ¼ö°¡ ¸¹Àºµ¥ ¿øÀÎÀº Àß ¸ð¸£Áö¸¸ PML
pleocytosis ´Â ÀϽÃÀûÀ̰í ÀúÀý·Î ȸº¹µÈ´Ù. bacterial meningitis°¡ superimposeµÈ °ÍÀº
¾Æ´Ï´Ù.