van Veen K E B, Brouwer M C, van der Ende A, van de Beek D
Department of Neurology, Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
Bone Marrow Transplant. 2016 Nov;51(11):1490-1495. doi: 10.1038/bmt.2016.181. Epub 2016 Jul 4.
We performed a nationwide prospective cohort study on the epidemiology and clinical features of community-acquired bacterial meningitis. Patients with a medical history of autologous or allogeneic hematopoietic stem cell transplantation (HSCT) were identified from the cohort performed from March 2006 to October 2014. Fourteen of 1449 episodes (1.0%) of bacterial meningitis occurred in patients with a history of HSCT. The incidence of bacterial meningitis in HSCT recipients was 40.4 per 100 000 patients per year (95% confidence interval (CI) 23.9-62.2), which is 30-fold (95% CI 18-51; P<0.001) higher compared with persons without HSCT. Incidence was higher in allogeneic HSCT compared with autologous HSCT (70.0 vs 15.8 per 100 000 patients per year). Causative organisms were Streptococcus pneumoniae in 11 patients, Neisseria meningitidis in two and Streptococcus mitis in one patient. Mortality was 3 of 14 (21%) and 6 of 11 (55%) survivors had sequelae. Nine of 11 patients (82%) with pneumococcal meningitis were infected with a serotype included in the 23-valent pneumococcal polysaccharide vaccine, of whom four developed meningitis despite vaccination. In conclusion, HSCT recipients have a substantially increased risk compared with the general population of acquiring bacterial meningitis, which is mostly due to S. pneumoniae, and disease is associated with high mortality and morbidity. Vaccination is important to prevent disease although vaccine failures did occur.
我们开展了一项关于社区获得性细菌性脑膜炎的流行病学和临床特征的全国性前瞻性队列研究。从2006年3月至2014年10月进行的队列研究中，识别出有自体或异体造血干细胞移植（HSCT）病史的患者。1449例细菌性脑膜炎发作中有14例（1.0%）发生在有HSCT病史的患者中。HSCT受者中细菌性脑膜炎的发病率为每年每100,000例患者40.4例（95%置信区间（CI）23.9 - 62.2），与无HSCT的人相比高30倍（95% CI 18 - 51；P<0.001）。异体HSCT的发病率高于自体HSCT（每年每100,000例患者分别为70.0例和15.8例）。致病微生物为肺炎链球菌11例、脑膜炎奈瑟菌2例、缓症链球菌1例。14例中有3例（21%）死亡，11例幸存者中有6例（55%）有后遗症。11例肺炎球菌性脑膜炎患者中有9例（82%）感染了23价肺炎球菌多糖疫苗所含的血清型，其中4例尽管接种了疫苗仍发生了脑膜炎。总之，与普通人群相比，HSCT受者患细菌性脑膜炎的风险大幅增加，这主要归因于肺炎链球菌，且该疾病与高死亡率和高发病率相关。尽管确实发生了疫苗接种失败的情况，但接种疫苗对于预防疾病很重要。
