Chao Yen-Nan, Chiu Nan-Chang, Huang Fu-Yuan
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
J Microbiol Immunol Infect. 2008 Feb;41(1):48-53.
Despite progress in antibiotic therapy and intensive care, childhood pneumococcal meningitis remains a devastating disease, with morbidity and mortality rates among the highest of any cause of bacterial meningitis. We conducted this study to find the factors associated with disease outcome in clinical settings.
All pediatric medical charts during the period from January 1984 to December 2003 with the diagnosis of pneumococcal meningitis were reviewed. We recorded patients' symptoms and signs, laboratory data and treatments. Outcome and neurological complications were also analyzed.
In total, 40 episodes of pneumococcal meningitis from 37 patients aged 3 months to 10 years were identified. Predisposing factors were found in 13 patients (35.1%), and included recent history of head injury, immunocompromised states and cranial base anomaly. All patients had fever during illness. Patients older than 24 months of age tended to complain of nuchal rigidity (19/21, 90.5%) and those younger than 6 months of age tended to present irritability (6/7, 85.7%). The overall mortality rate was 25% (10 out of 40 episodes). The following variables were associated with mortality after statistical analysis: consciousness disturbance, shock, endotracheal tube intubation and hyponatremia (sodium <130 mEq/L) at admission (p=0.001, p<0.001, p<0.001, and p=0.012, respectively). Also, laboratory findings of less than 20/mm3 white cell count in cerebrospinal fluid (CSF), lower CSF glucose level and CSF-to-blood glucose ratio were significantly higher in non-survivors (p=0.003, p=0.009, p=0.027). Variables associated with morbidity were seizure attack and focal neurological sign occurring hospitalization (p=0.017, p=0.017).
The mortality of childhood pneumococcal meningitis remains high. If a child with pneumococcal meningitis presents with consciousness disturbance, hypotension, endotracheal intubation or hyponatremia at admission, the disease mortality rate increases. CSF findings with low white cell count, low glucose level and CSF-to-blood glucose ratio are also warning signs of a bad outcome. Seizure attack and focal neurological sign are the factors associated with further neurological sequelae.
尽管抗生素治疗和重症监护取得了进展，但儿童肺炎球菌性脑膜炎仍然是一种毁灭性疾病，其发病率和死亡率在细菌性脑膜炎病因中位居前列。我们开展这项研究以找出临床环境中与疾病预后相关的因素。
回顾了1984年1月至2003年12月期间所有诊断为肺炎球菌性脑膜炎的儿科病历。我们记录了患者的症状和体征、实验室数据及治疗情况。还对预后和神经系统并发症进行了分析。
共确定了37例年龄在3个月至10岁之间的患者发生的40次肺炎球菌性脑膜炎发作。在13例患者（35.1%）中发现了易感因素，包括近期头部受伤史、免疫功能低下状态和颅底异常。所有患者在患病期间均有发热。24个月以上的患者倾向于诉说颈部强直（19/21，90.5%），6个月以下的患者倾向于表现出易激惹（6/7，85.7%）。总体死亡率为25%（40次发作中有10例）。经统计分析，以下变量与死亡率相关：意识障碍、休克、气管插管和入院时低钠血症（钠<130 mEq/L）（分别为p=0.001、p<0.001、p<0.001和p=0.012）。此外，脑脊液（CSF）白细胞计数低于20/mm3、脑脊液葡萄糖水平较低以及脑脊液与血糖比值在非幸存者中显著更高（p=0.003、p=0.009、p=0.027）。与发病率相关的变量是住院期间发生的癫痫发作和局灶性神经体征（p=0.017、p=0.017）。
儿童肺炎球菌性脑膜炎的死亡率仍然很高。如果患有肺炎球菌性脑膜炎的儿童入院时出现意识障碍、低血压、气管插管或低钠血症，疾病死亡率会增加。脑脊液白细胞计数低、葡萄糖水平低以及脑脊液与血糖比值也是预后不良的警示信号。癫痫发作和局灶性神经体征是与进一步神经后遗症相关的因素。
