Caliman-Sturdza Olga Adriana, Mihalache Doina, Luca Cătălina Mihaela, Dorobăţ Carmen
Doctorand al Universităţii de Medicină şi Farmacie Gr.T. Popa Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2010 Jul-Sep;114(3):743-7.
The aim of the study was to investigate the particularities of the clinical manifestation and evolution of tuberculous meningitis at children.
The study was made between January 2000 and December 2008 in Clinic of Infectious Diseases IaSi and Emergency County Hospital ,,Sf. Ioan cel Nou" Suceava on a group of 169 children with tuberculous meningitis.
The majority (78.1%) of patients had poor socio-economic conditions and 22.4$ had a family TB contact. The onset of the symptoms was atypical in infants and small children with fever associated with digestive, neurological or pulmonary manifestations. The admission in hospital was delayed in 56.8% of patients and 39.05% had a severe general status with coma. The positive diagnosis was based on cytological and biochemical features of CSF, results of QuantilFERON. TB Gold, pulmonary images, family TB contact and evolution under anti-tuberculous therapy. We observed a high rate of complications represented by hydrocephaly (28.9%). 18 patients died (4 infants), the cause of dead being meningeal coma or complications.
The diagnosis of tuberculous meningitis at children remains a problem because of the atypical clinical manifestation, the delay of initiating the therapy causing high mortality and frequent complications.
本研究的目的是调查儿童结核性脑膜炎临床表现及病情发展的特殊性。
本研究于2000年1月至2008年12月在雅西传染病诊所和苏恰瓦县“圣伊万·塞尔·诺乌”急救医院对169例儿童结核性脑膜炎患者进行。
大多数患者(78.1%)社会经济条件差,22.4%有家庭结核病接触史。婴幼儿症状发作不典型,伴有发热及消化、神经或肺部表现。56.8%的患者入院延迟,39.05%的患者一般状况严重,伴有昏迷。阳性诊断基于脑脊液的细胞学和生化特征、结核菌素释放试验结果、肺部影像、家庭结核病接触史及抗结核治疗后的病情发展。我们观察到并发症发生率较高,以脑积水(28.9%)为代表。18例患者死亡(4例婴儿),死亡原因是脑膜昏迷或并发症。
由于临床表现不典型、治疗启动延迟导致高死亡率和频繁并发症,儿童结核性脑膜炎的诊断仍然是一个问题。