Barquet N, Gasser I, Domingo P, Moraga F A, Macaya A, Elcuaz R
Hospital Infantil Vall d' Hebron, Spain.
Rev Infect Dis. 1990 Sep-Oct;12(5):838-47. doi: 10.1093/clinids/12.5.838.
Neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis. Twenty-one cases of primary meningococcal conjunctivitis (PMC) are reported herein and 63 cases published in the literature since 1899 are reviewed. In the 84 cases of PMC available for analysis, the male-to-female ratio was 1.76:1; nine of the patients were neonates, 55 were children, and 20 were adults. Conjunctivitis was unilateral in 66.3% of the patients. Gram stain of conjunctival exudate disclosed gram-negative diplococci in all cases in which it was done. Culture of the conjunctival exudate yielded N. meningitidis in all cases, and 44% of the isolated meningococci belonged to serogroup B. Ocular complications, which occurred in 15.5% of the patients, most frequently were corneal ulcers. Systemic meningococcal disease developed in 17.8% of the patients; the overall mortality was 13.3% for patients with PMC complicated by systemic disease. Development of systemic disease was significantly more frequent in patients receiving only topical therapy than in those treated with systemic therapy (31.71% vs. 2.38%; P = .001). Gram-negative diplococci observed in conjunctival exudate are an indication for systemic antibiotic therapy because of the risk of systemic complications associated with the use of topical therapy alone. When properly treated, patients with PMC have a favorable prognosis.
脑膜炎奈瑟菌是急性细菌性结膜炎的罕见病因。本文报告了21例原发性脑膜炎球菌性结膜炎（PMC），并对自1899年以来文献中发表的63例病例进行了回顾。在可用于分析的84例PMC病例中，男女比例为1.76:1；9例患者为新生儿，55例为儿童，20例为成人。66.3%的患者结膜炎为单侧。在所有进行结膜渗出物革兰氏染色的病例中均发现革兰氏阴性双球菌。所有病例的结膜渗出物培养均检出脑膜炎奈瑟菌，分离出的脑膜炎球菌中有44%属于B血清群。15.5%的患者出现眼部并发症，最常见的是角膜溃疡。17.8%的患者发生了全身性脑膜炎球菌病；PMC合并全身性疾病患者的总体死亡率为13.3%。仅接受局部治疗的患者发生全身性疾病的频率显著高于接受全身治疗的患者（31.71%对2.38%；P = 0.001）。由于单独使用局部治疗存在全身性并发症的风险，在结膜渗出物中观察到革兰氏阴性双球菌是进行全身性抗生素治疗的指征。PMC患者经适当治疗后预后良好。
