Silva Hagamenon R, Tanajura Gustavo Mustafa, Tavares-Neto José, Gomes Md Maria de Lourdes C, Linhares Ad Alexandre da Costa, Vasconcelos Pedro F C, Ko Albert Icksang
Departamento de Pediatria, Faculdade de Medicina, Universidade Federal da Bahia, Brasil.
Rev Soc Bras Med Trop. 2002 Mar-Apr;35(2):159-65. doi: 10.1590/s0037-86822002000200006.
For the purpose of identifying the frequency that enterovirus, leptospires, arbovirus cause aseptic meningitis syndrome (AMS) during non-epidemic periods and comparing patients with and without laboratory evidence for an etiologic agent, 112 patients were selected aged between 3 months and 15 years and a clinical suspicion of AMS and were referred to Couto Maia Hospital, the Infectious and Parasitic Disease Reference Center for Salvador, Bahia. In 44.6% (n=50), the etiologic agent for the diagnosis was laboratory-confirmed: enterovirus was identified in 37.7% (n=42) of the cases by the PCR Amplicor diagnostic kit, cerebrospinal fluid or fecal culture isolation; Leptospira sp. in 7.12% (n=8) by the microagglutination test; and arbovirus in non of the cases by inhibition of passive hemagglutination. In 14 of the 22 enteroviral isolates that were evaluated, 6 different serotypes were identified with Echovirus-4 being the major serotype (27.2%; 6/22) among all found (Coxsackie B2, B3, B6 and B9; Enterovirus 71). In conclusion, enteroviruses were the most frequent etiologic agent of AMS and that leptospirosis should be included in the differential diagnosis. In addition, patients with and without laboratory-confirmed identification of the etiologic agent had similar demographic and clinical characteristics and cerebrospinal fluid findings (p >0.05), therefore suggesting that patients without a confirmed diagnosis had enteroviral or leptospiral etiologies.
为了确定肠道病毒、钩端螺旋体、虫媒病毒在非流行期间引起无菌性脑膜炎综合征(AMS)的频率,并比较有和没有病原体实验室证据的患者,选取了112名年龄在3个月至15岁之间、临床怀疑患有AMS的患者,并将他们转诊至库托·马亚医院,该医院是巴伊亚州萨尔瓦多市的传染病和寄生虫病参考中心。在44.6%(n = 50)的病例中,诊断的病原体得到实验室确认:通过PCR Amplicor诊断试剂盒、脑脊液或粪便培养分离,在37.7%(n = 42)的病例中鉴定出肠道病毒;通过显微凝集试验在7.12%(n = 8)的病例中鉴定出钩端螺旋体属;通过被动血凝抑制试验在所有病例中均未鉴定出虫媒病毒。在评估的22株肠道病毒分离株中,鉴定出6种不同血清型,其中埃可病毒4型是所有发现的血清型中主要的血清型(27.2%;6/22)(柯萨奇B2、B3、B6和B9型;肠道病毒71型)。总之,肠道病毒是AMS最常见的病原体,钩端螺旋体病应纳入鉴别诊断。此外,有和没有病原体实验室确诊的患者在人口统计学和临床特征以及脑脊液检查结果方面相似(p>0.05),因此表明未确诊的患者病因是肠道病毒或钩端螺旋体。