Sadarangani Manish, Willis Louise, Kadambari Seilesh, Gormley Stuart, Young Zoe, Beckley Rebecca, Gantlett Katherine, Orf Katharine, Blakey Sarah, Martin Natalie G, Kelly Dominic F, Heath Paul T, Nadel Simon, Pollard Andrew J
Department of Paediatrics, University of Oxford, and the NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.
Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George's, University of London, London, UK.
Arch Dis Child. 2015 Mar;100(3):292-4. doi: 10.1136/archdischild-2014-306813. Epub 2014 Sep 25.
Bacterial conjugate vaccines have dramatically changed the epidemiology of childhood meningitis; viral causes are increasingly predominant, but the current UK epidemiology is unknown. This prospective study recruited children under 16 years of age admitted to 3 UK hospitals with suspected meningitis. 70/388 children had meningitis-13 bacterial, 26 viral and 29 with no pathogen identified. Group B Streptococcus was the most common bacterial pathogen. Infants under 3 months of age with bacterial meningitis were more likely to have a reduced Glasgow Coma Score and respiratory distress than those with viral meningitis or other infections. There were no discriminatory clinical features in older children. Cerebrospinal fluid (CSF) white blood cell count and plasma C-reactive protein at all ages, and CSF protein in infants <3 months of age, distinguished between bacterial meningitis and viral meningitis or other infections. Improved diagnosis of non-bacterial meningitis is urgently needed to reduce antibiotic use and hospital stay.
细菌结合疫苗极大地改变了儿童脑膜炎的流行病学状况；病毒病因日益占主导地位，但英国目前的流行病学情况尚不清楚。这项前瞻性研究招募了英国3家医院收治的疑似脑膜炎的16岁以下儿童。388名儿童中有70名患脑膜炎——13名细菌感染、26名病毒感染，29名未查明病原体。B组链球菌是最常见的细菌病原体。3个月以下患细菌性脑膜炎的婴儿比患病毒性脑膜炎或其他感染的婴儿更有可能出现格拉斯哥昏迷评分降低和呼吸窘迫。年龄较大的儿童没有可区分的临床特征。各年龄段的脑脊液白细胞计数和血浆C反应蛋白，以及3个月以下婴儿的脑脊液蛋白，可区分细菌性脑膜炎与病毒性脑膜炎或其他感染。迫切需要改进非细菌性脑膜炎的诊断，以减少抗生素使用和住院时间。
