5岁及以上细菌性脑膜炎/脑膜脑炎患儿39例临床特征分析  

Clinical characteristics of bacterial meningitis/meningoencephalitis in children aged 5 years and over:an analysis of 39 cases

作　　者：张建昭[1] 孙静[1] 李冠男[1] 郑萍[1] 李冬青[1] 刘钊[1] 马才惠 杨健[1] ZHANG Jianzhao;SUN Jing;LI Guannan;ZHENG Ping;LI Dongqing;LIU Zhao;MA Caihui;YANG Jian(Department of Pediatric Neurology,Children’s Hospital Affiliated to the Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院,北京100020

出　　处：《临床儿科杂志》2023年第5期376-380,共5页Journal of Clinical Pediatrics

摘　　要：目的 分析5岁及以上细菌性脑膜炎/脑膜脑炎患儿的临床特征。方法 回顾性分析首都儿科研究所附属儿童医院神经内科住院的细菌性脑膜炎/脑膜脑炎患儿的临床资料。结果 共收集到5岁及以上细菌性脑膜炎/脑膜脑炎患儿39例,男28例,女11例,年龄5-15岁。病因包括鼻部感染11例(28.2%)、耳道感染5例(12.8%)、外伤3例(7.7%)、免疫缺陷病3例(7.7%)、面部蜂窝织炎2例(5.1%)、解剖结构异常(皮样囊肿)1例(2.7%)、中枢神经系统肿瘤(淋巴瘤)1例(2.7%)、不明原因13例(33.3%)。症状包括发热、头痛、呕吐、意识障碍、惊厥、瘫痪、面瘫、惊厥持续状态等。15例(38.5%)患儿脑脊液中发现病原(包括淋病奈瑟菌、肺炎链球菌、产碱假单胞菌、皮氏罗尔斯顿菌、克氏库克菌、玫瑰单胞菌、金黄色葡萄球菌、中间链球菌、星座链球菌、产单核细胞李斯特菌),其中二代测序发现病原10例、脑脊液培养发现6例。头颅磁共振成像异常17例(43.6%)。并发症或后遗症包括硬膜下积液35例(89.7%)、硬膜下积脓6例(15.4%)、脑疝6例(15.4%)、脑积水3例(7.7%)、言语障碍2例(5.1%),死亡1例(2.7%)。结论 对于5岁及以上大龄细菌性脑膜炎/脑膜脑炎患儿应积极寻找病因,如颅内皮样囊肿、中枢神经系统原发肿瘤、头面部蜂窝织炎、鼻窦炎、免疫缺陷病和外伤等疾病。Objective To analyze the clinical characteristics of bacterial meningitis/meningoencephalitis in children aged 5 years and above.Methods The clinical data of hospitalized children with bacterial meningitis/meningoencephalitis in the department of neurology in the hospital were retrospectively analyzed.Results A total of 39(7.8%)children,28 males and 11 females,aged 5-15 years with bacterial meningitis/meningoencephalitis were enrolled.The etiology included:nasal infection in 11 cases(28.2%),ear infection in 5 cases(12.8%),trauma in 3 cases(7.7%),immunodeficiency disease in 3 cases(7.7%),facial cellulitis in 2 cases(5.1%),anatomical abnormalities(dermoid cysts)in 1 case(2.7%),central nervous system tumors(lymphoma)in 1 case(2.7%),and unknown causes in 13 cases(33.3%).Symptoms include fever,headache,vomiting,disturbance of consciousness,convulsions,paralysis,facial paralysis and convulsive persistence.Pathogens were found in cerebrospinal fluid of 15 children(38.5%),including Neisseria gonorrhoeae,Streptococcus pneumoniae,Pseudomonas aeruginosa,Ralstonia pipiensis,Micrococcus kristinae,Rosemonas,Staphylococcus aureus,Streptococcus intermedius,Streptococcus constellatus and Listeria monocytogenes.Among them,pathogens of 10 cases were found by second generation sequencing,and 6 cases were found by cerebrospinal fluid culture.There were 17 cases(43.6%)with abnormal magnetic resonance imaging of the skull.Complications or sequelae included:subdural effusion in 35 cases(89.7%),subdural pus in 6 cases(15.4%),cerebral hernia in 6 cases(15.4%),hydrocephalus in 3 cases(7.7%),speech impairment in 2 cases(5.1%),and death in 1 case(2.7%).Conclusions The etiology of bacterial meningitis/meningoencephalitis in children aged 5 years or older should be actively sought,such as intracranial endothelioid cysts,primary tumors of the central nervous system,cellulitis of the head and face,sinusitis,immunodeficiency diseases,and trauma.

关 键 词：脑膜炎 脑膜脑炎 年龄 细菌 儿童 

分 类 号：R742.9[医药卫生—神经病学与精神病学]