Papua New Guinea Institute of Medical Research, Madang and Goroka, Papua New Guinea.
Am J Trop Med Hyg. 2012 Feb;86(2):240-5. doi: 10.4269/ajtmh.2012.11-0312.
Predictors of acute bacterial meningitis (ABM) were assessed in 554 children in Papua New Guinea 0.2-10 years of age who were hospitalized with culture-proven meningitis, probable meningitis, or non-meningitic illness investigated by lumbar puncture. Forty-seven (8.5%) had proven meningitis and 36 (6.5%) had probable meningitis. Neck stiffness, Kernig's and Brudzinski's signs and, in children < 18 months of age, a bulging fontanel had positive likelihood ratios (LRs) ≥ 4.3 for proven/probable ABM. Multiple seizures and deep coma were less predictive (LR = 1.5-2.1). Single seizures and malaria parasitemia had low LRs (≤ 0.5). In logistic regression including clinical variables, Kernig's sign and deep coma were positively associated with ABM, and a single seizure was negatively associated (P ≤ 0.01). In models including microscopy, neck stiffness and deep coma were positively associated with ABM and parasitemia was negatively associated with ABM (P ≤ 0.04). In young children, a bulging fontanel added to the model (P < 0.001). Simple clinical features predict ABM in children in Papua New Guinea but malaria microscopy augments diagnostic precision.
在巴布亚新几内亚，对 554 名 0.2-10 岁因确诊脑膜炎、疑似脑膜炎或经腰椎穿刺检查排除脑膜炎的住院儿童进行了急性细菌性脑膜炎（ABM）的预测因素评估。47 例（8.5%）为确诊脑膜炎，36 例（6.5%）为疑似脑膜炎。颈强直、克尼格氏征和布鲁津斯基征，以及<18 个月龄的儿童前囟隆起，对确诊/疑似 ABM 的阳性似然比（LR）≥4.3。多次惊厥和深度昏迷的预测性较低（LR=1.5-2.1）。单次惊厥和疟疾寄生虫血症的 LR 较低（≤0.5）。在包含临床变量的逻辑回归中，克尼格氏征和深度昏迷与 ABM 呈正相关，单次惊厥与 ABM 呈负相关（P≤0.01）。在包含显微镜检查的模型中，颈强直和深度昏迷与 ABM 呈正相关，寄生虫血症与 ABM 呈负相关（P≤0.04）。在幼儿中，前囟隆起增加了模型的预测能力（P<0.001）。简单的临床特征可预测巴布亚新几内亚儿童的 ABM，但疟疾显微镜检查可提高诊断准确性。
