Bryan J P, de Silva H R, Tavares A, Rocha H, Scheld W M
Department of Internal Medicine, University of Virginia School of Medicine, Charlottesville.
Rev Infect Dis. 1990 Jan-Feb;12(1):128-35. doi: 10.1093/clinids/12.1.128.
Little is known of the current incidence and mortality of meningitis in developing nations, especially in Latin America. We reviewed all cases of meningitis in an isolation-fever hospital in Salvador, Brazil, for the decade 1973-1982. Of all admissions, 6,751 (27%) were for meningitis; 4,100 (61%) of these cases were of definite or probable bacterial etiology. Children younger than 15 years accounted for 79% of cases, and 45% of cases were in children under 2 years. The overall case fatality rate was 33%, with 50% of these deaths occurring within 48 hours of hospitalization. Neisseria meningitidis was the etiologic agent in 32% of the cases, with a case fatality rate of 14%. Epidemics caused by N. meningitidis group C, then group A, in 1974-1978 accounted for 60% of the cases. Streptococcus pneumoniae caused 17% of cases, with a case fatality rate of 59%. Haemophilus influenzae type b, the most common cause of nonepidemic meningitis, caused 23% of all cases, with a case fatality rate of 38%. Enterobacteriaceae were the etiology in only 3.6% of patients, but the case fatality rate was 86%. Cultures were negative in 18% of cases with purulent cerebrospinal fluid. A total of 84% of H. influenzae, 40% of S. pneumoniae, 78% of Enterobacteriaceae, and 15% of N. meningitidis cases occurred in children less than 2 years of age. Case fatality rates were highest in this group. Vaccines protective for this age group are urgently needed.
关于发展中国家，尤其是拉丁美洲目前脑膜炎的发病率和死亡率，人们知之甚少。我们回顾了1973年至1982年这十年间巴西萨尔瓦多一家隔离发热医院的所有脑膜炎病例。在所有入院病例中，6751例（27%）是因脑膜炎入院；其中4100例（61%）为明确或可能的细菌病因。15岁以下儿童占病例的79%，45%的病例为2岁以下儿童。总体病死率为33%，其中50%的死亡发生在住院48小时内。脑膜炎奈瑟菌是32%病例的病原体，病死率为14%。1974年至1978年由C群脑膜炎奈瑟菌引起的疫情，随后是A群，占病例的60%。肺炎链球菌导致17%的病例，病死率为59%。b型流感嗜血杆菌是非流行性脑膜炎最常见的病因，占所有病例的23%，病死率为38%。肠杆菌科仅占患者病因的3.6%，但病死率为86%。18%的化脓性脑脊液病例培养结果为阴性。84%的流感嗜血杆菌、40%的肺炎链球菌、78%的肠杆菌科和15%的脑膜炎奈瑟菌病例发生在2岁以下儿童中。该年龄组的病死率最高。迫切需要针对该年龄组的保护性疫苗。
