Shamsad I A, Begum T
Department of Paediatrics, Sir Salimullah Medical College, Dhaka, Bangladesh.
Mymensingh Med J. 2009 Jul;18(2):232-8.
Childhood meningitis is still a major cause of neurological disabilities and death, which can be reduced by early initiation of treatment. This study was done with an objective to diagnose childhood meningitis earlier based on clinical characteristics and early obtainable cerebrospinal fluid (CSF) indices, which help to start early empiric treatment and prevent worse prognosis. The study was conducted during the period of January to December; 2003. One hundred suspected cases of childhood meningitis aged 1 month to 12 years admitted into the Department of Paediatrics, Dhaka Medical College Hospital, Dhaka, Bangladesh were selected for the study. It was a prospective study and sampling was purposive. Diagnosis was made by history, clinical examination, complete blood count and CSF study. Early treatment was started. Number of deaths was noted and neurological outcome was assessed in children who survived by clinical examination at the time of discharge. Study results showed 64% bacterial, 20% tuberculous and 6% viral meningitis. Fever (100%), altered consciousness (100%) were the most common features in all type of meningitis. Other predominant features were convulsion (90%), bulged fontanel (68%), reluctant to feed (67.18%), neck rigidity (67%) and vomiting(43.75%) in bacterial meningitis, convulsion (75%), neck rigidity (65%), vomiting (40%) and focal neurological signs (35%) in tuberculous meningitis, reluctant to feed (100%), convulsion (83.3%), neck rigidity (83.3%) and vomiting (66.6%) in viral meningitis. In all cases of meningitis CSF total leukocyte count was >5/mm3. Regarding immediate outcome in bacterial meningitis 48.8% improved without neurological sequelae, 43.7% patient developed neurological sequelae and 4.6% patient died. In tuberculous group, only 30% improved without neurological sequelae, 40% developed neurological sequelae and 20% patient died. In viral meningitis 83.3% improved without neurological sequelae. Duration of the main complaint specially fever at the time of presentation, level of consciousness, convulsion were the most important predictor of out come in childhood meningitis.
儿童脑膜炎仍然是导致神经残疾和死亡的主要原因，早期开始治疗可降低其发生率。本研究旨在根据临床特征和早期可获得的脑脊液（CSF）指标更早地诊断儿童脑膜炎，这有助于尽早开始经验性治疗并预防更差的预后。该研究于2003年1月至12月期间进行。选取了孟加拉国达卡达卡医学院医院儿科收治的100例年龄在1个月至12岁的疑似儿童脑膜炎病例进行研究。这是一项前瞻性研究，采用目的抽样法。通过病史、临床检查、全血细胞计数和脑脊液检查进行诊断。开始早期治疗。记录死亡人数，并在出院时通过临床检查对存活儿童的神经学转归进行评估。研究结果显示，细菌性脑膜炎占64%，结核性脑膜炎占20%，病毒性脑膜炎占6%。发热（100%）、意识改变（100%）是所有类型脑膜炎最常见的特征。细菌性脑膜炎的其他主要特征为惊厥（90%）、囟门隆起（68%）、拒食（67.18%）、颈部强直（67%）和呕吐（43.75%）；结核性脑膜炎为惊厥（75%）、颈部强直（65%）、呕吐（40%）和局灶性神经体征（35%）；病毒性脑膜炎为拒食（100%）、惊厥（83.3%）、颈部强直（83.3%）和呕吐（66.6%）。在所有脑膜炎病例中，脑脊液白细胞总数均>5/mm³。关于细菌性脑膜炎的近期转归，48.8%好转且无神经后遗症，43.7%的患者出现神经后遗症，4.6%的患者死亡。在结核性脑膜炎组，仅30%好转且无神经后遗症，40%出现神经后遗症，20%的患者死亡。在病毒性脑膜炎中，83.3%好转且无神经后遗症。主要症状的持续时间，特别是就诊时发热的持续时间、意识水平、惊厥是儿童脑膜炎转归的最重要预测因素。
