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Reprogramming the host response in bacterial meningitis: how best to improve outcome?
Clinical Microbiology Reviews ( IF 36.8 ) Pub Date : 2003-07-15 , DOI: 10.1128/cmr.16.3.415-429.2003
M van der Flier 1 , S P M Geelen , J L L Kimpen , I M Hoepelman , E I Tuomanen
Affiliation  

Despite effective antibiotic therapy, bacterial meningitis is still associated with high morbidity and mortality in both children and adults. Animal studies have shown that the host inflammatory response induced by bacterial products in the subarachnoid space is associated with central nervous system injury. Thus, attenuation of inflammation early in the disease process might improve the outcome. The feasibility of such an approach is demonstrated by the reduction in neurologic sequelae achieved with adjuvant dexamethasone therapy. Increased understanding of the pathways of inflammation and neuronal damage has suggested rational new targets to modulate the host response in bacterial meningitis, but prediction of which agents would be optimal has been difficult. This review compares the future promise of benefit from the use of diverse adjuvant agents. It appears unlikely that inhibition of a single proinflammatory mediator will prove useful in clinical practice, but several avenues to reprogram a wider array of mediators simultaneously are encouraging. Particularly promising are efforts to adjust combinations of cytokines, to inhibit neuronal apoptosis and to enhance brain repair.

中文翻译:

重新编程细菌性脑膜炎的宿主反应:如何最好地改善预后?

尽管有效的抗生素治疗,细菌性脑膜炎仍然与儿童和成人的高发病率和高死亡率有关。动物研究表明,蛛网膜下腔中细菌产物诱导的宿主炎症反应与中枢神经系统损伤有关。因此,在疾病过程早期减轻炎症可能会改善预后。通过辅助地塞米松治疗可减少神经后遗症,证明了这种方法的可行性。人们对炎症和神经元损伤途径的了解日益增加,已经提出了合理的新靶标来调节细菌性脑膜炎中的宿主反应,但是很难预测哪种药物是最佳的。这篇综述比较了使用多种佐剂对未来的益处。抑制单个促炎介质的作用似乎不太可能在临床实践中证明是有用的,但是同时重新编程更多种介质的几种途径令人鼓舞。特别有希望的是调节细胞因子组合,抑制神经元凋亡和增强脑修复的努力。
更新日期:2019-11-01
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