The management of tuberculous meningitis.
The management of tuberculous meningitis.
复制标题
结核性脑膜炎的治疗。
作者：
M. Humphries
结核性脑膜炎是一种危及生命的结核病，也是最常见的中枢神经系统结核病。这种疾病是发展中国家发病率和死亡率的严重原因，但在技术先进的国家很少见。这可能反映了结核病的全球流行病学，因为在每年估计的800万新病例中，有700万至600万(95%)发生在第三世界。1983年在英格兰和威尔士，白人患者的结核性脑膜炎发病率为0.1/10万，而印度次大陆族裔患者的发病率却高出40倍(4/10万)。2自1982年以来，英格兰和威尔士的呈报病例总数一直低于100例；1990年有81例呈报(JM Watson和K Fern，个人交流)，主要发生在成年人。肺结核已成为艾滋病患者的一个重要临床问题，与其相关的复杂、34和肺外疾病尤为常见。中枢神经系统结核是其重要表现。在一项对美国420名艾滋病患者或艾滋病相关复合体患者的审查中，52人患上了结核病，10人中枢神经系统受到影响，在欧洲报告的艾滋病毒感染患者中，每000.5人中有2000人以上的比率。结核分枝杆菌是脑膜炎的最常见原因，
Tuberculous meningitis is a life threatening form of tuberculosis and the most common form of central nervous system tuberculosis. The condition is a serious cause of morbidity and mortality in developing nations, but is rare in technically advanced countries. This probably reflects the global epidemiology of tuberculosis, for out of an estimated 8 million new cases annually 7-6 million (95%) occur in the third world.' In England and Wales in 1983 the rate of tuberculous meningitis for white patients was 0 1/ 100 000, yet was 40 times higher (a rate of 4/100 000) in patients of Indian subcontinent ethnic origin.2 The total number of cases notified in England and Wales has remained below 100 since 1982; there were 81 notifications in 1990 (JM Watson and K Fern, personal communication), predominantly in adults. Tuberculosis has emerged as an important clinical problem in patients with AIDS and its related complex,34 and extrapulmonary disease is particularly common. Central nervous system tuberculosis is an important manifestation. In one review of420 patients in the United States with AIDS or the AIDS related complex 52 developed tuberculosis, 10 having the central nervous system affected, a rate ofmore than 2000 per 100 000.5 In a population ofHIV infected patients reported from Europe Mycobacterium tuberculosis was the most common cause of meningitis, with