细菌性脑膜炎的病原菌常为固紫阴性菌,如脑膜炎球菌、流感杆菌、肺炎杆菌和大肠杆菌。部分固紫阳性菌如肺炎球菌、李司特杆菌、链球菌和葡萄球菌也可引起脑膜炎。脑膜炎球菌是经呼吸道传播的,其他细菌性脑膜炎常继发于中枢神经系统畸形(如椎管裂)、外伤手术、脑脊液鼻漏、中耳炎、鼻窦炎和败血症等疾病。细菌性脑膜炎的诊断有赖于流行病学资料,临床表现、血液与脑脊液(CSF)的生化及病原学检查。Sotto报告流脑患者皮肤瘀点切片在光镜和电镜下有血管损伤、血栓形成和脑膜炎球菌繁殖,用免疫萤光方法可见毛细管和真皮小血管壁有IgG、IgM、IgA、C_3和纤维蛋白原颗粒凝集。以上方法在临床上难以广泛应用,但瘀点,瘀斑的渗出液涂片寻找脑膜炎球菌则已推广。以往报告脑膜炎患者发生菌血症约40～92％,但血培养的阳性率常因培养条件不适或抗菌治疗而降低。给狗椎管内接种肺炎球菌后,40％可发生肺炎球菌菌血症。 CSF的细菌学检查可提供细菌在脑膜繁殖的直接证据。CSF离心后涂片作固紫染色和CSF细菌培养在脑膜炎病房应列为常规。但涂 Bacterial meningitis pathogens are often solid purple-negative bacteria, such as meningococci, influenza bacilli, Klebsiella pneumoniae and Escherichia coli. Some solid-violet positive bacteria such as pneumococcus, listeria, streptococcus and staphylococci can also cause meningitis. Meningococci are transmitted via the respiratory tract. Other bacterial meningitis are often secondary to central nervous system deformities (such as spinal fractures), traumatic surgery, cerebrospinal fluid rhinorrhea, otitis media, sinusitis and sepsis. Bacterial meningitis depends on the diagnosis of epidemiological data, clinical manifestations, blood and cerebrospinal fluid (CSF) biochemical and etiological examination. Sotto reported that skin petechiae in patients with meningitis had vascular lesions, thrombosis and meningococcal infection under light and electron microscopy. Immunofluorescence showed that there were IgG, IgM, IgA, C_3 and fibrin in the capillary and dermal small blood vessel walls The original particle agglutination. The above method is difficult to be widely used clinically, but petechia, ecchymosis exudate smear to find meningococcal has been promoted. In the past, meningitis occurred in patients with bacteremia about 40 ~ 92%, but the positive rate of blood culture often because of discomfort or antimicrobial therapy to reduce culture conditions. Inoculation of pneumococcal vertebrae to dogs, 40% of pneumococcal bacteremia can occur. Bacteriological examination of CSF can provide direct evidence of bacterial multiplication at the meninges. CSF centrifugal smear for solid purple staining and CSF bacterial culture in the meningitis ward should be routine. But painted