Al-Mazrou Yagob Y, Musa Elgeili K, Abdalla Mohamed N, Al-Jeffri Mohamed H, Al-Hajjar Sami H, Mohamed Omer M
Department of Preventive Medicine, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.
Saudi Med J. 2003 Dec;24(12):1300-7.
This study was designed to explore the case management and disease burden of bacterial meningitis among children below the age of 5 years in the Kingdom of Saudi Arabia.
A prospective descriptive study was conducted during June 1999 through to May 2001 in 8 hospitals from 5 cities in different areas of the country. Those were, King Fahad Specialist Hospital and Maternity & Children Hospital, Buraidah, Belgorashi General Hospital and King Fahad Specialist Hospital, Al-Baha, Maternity & Children Hospital and Ohud Hospital, Al-Madina, Al-Qatif General Hospital in the Eastern Region and Prince Abdulrahman Bin Ahmed Alsudairy Central Hospital, Sakaka. The study population was 171,818 children under the age of 5 years.
During the study period 208 cases of bacterial meningitis were identified, 141 (67.8%) with a definite causative organism: Hemophilus influenzae type b, Neisseria meningitidis, Streptococcus pneumoniae and other bacterial species. The remaining 67 cases (32%) were labeled as aseptic meningitis. A considerable proportion of cases was found to have received an antibiotic prior to presentation. While symptoms such as fever or poor feeding were common among cases, meningeal signs were less prominent. A lumbar puncture was carried out on all cases to reach diagnosis by gram stain, latex agglutination test and cerebrospinal fluid (CSF) and blood cultures following standard procedures. The immediate burden of meningitis cases was found to be the lengthy stay of patients in the hospital wards and intensive care units. Some of the main causative agents were resistant to the conventional antimicrobial therapy, but susceptible to newer antibiotics.
The study being based on a population based surveillance gave a better overview on causative organisms of meningitis emphasizing that Gram stain, serology of CSF and culture (of CSF and blood) should be used. A high index of suspicion is needed to diagnose meningitis in children. Lumbar tap should be encouraged and supported in terms of training and more authorization to apply in diagnostic tests of such conditions. Audiometric measurement is a crucial need in the assessment of meningitis cases and in the process of their follow up. This type of service is clearly missing in our system. Influential steps are to be planned to avail this service.
本研究旨在探讨沙特阿拉伯王国5岁以下儿童细菌性脑膜炎的病例管理及疾病负担。
1999年6月至2001年5月，在该国不同地区5个城市的8家医院开展了一项前瞻性描述性研究。这些医院分别是布赖代的法赫德国王专科医院和妇幼医院、巴哈的贝尔戈拉希综合医院和法赫德国王专科医院、麦地那的妇幼医院和奥胡德医院、东部地区的卡提夫综合医院以及萨卡卡的阿卜杜勒拉赫曼·本·艾哈迈德·苏代里王子中央医院。研究人群为171,818名5岁以下儿童。
在研究期间，共确诊208例细菌性脑膜炎病例，其中141例（67.8%）有明确的致病微生物：b型流感嗜血杆菌、脑膜炎奈瑟菌、肺炎链球菌及其他细菌种类。其余67例（32%）被诊断为无菌性脑膜炎。相当一部分病例在就诊前已接受过抗生素治疗。虽然发热或喂养困难等症状在病例中很常见，但脑膜刺激征并不明显。所有病例均按照标准程序进行腰椎穿刺，通过革兰氏染色、乳胶凝集试验以及脑脊液（CSF）和血培养来确诊。发现脑膜炎病例的直接负担是患者在医院病房和重症监护病房的长时间住院。一些主要病原体对传统抗菌治疗耐药，但对新型抗生素敏感。
基于人群监测开展的本研究对脑膜炎的致病微生物有了更好的总体认识，强调应采用革兰氏染色、脑脊液血清学检查以及（脑脊液和血液）培养。诊断儿童脑膜炎需要高度的怀疑指数。应鼓励进行腰椎穿刺，并在培训和更多授权方面给予支持，以便在这类疾病的诊断测试中应用。听力测量对于脑膜炎病例的评估及其随访过程至关重要。我们的系统明显缺乏这类服务。应规划有影响力的措施来提供这项服务。
