Shahrin Lubaba, Chisti Mohammod Jobayer, Huq Sayeeda, Islam Md Munirul, Sarker Shafiqul Alam, Begum Mahmuda, Saha Shukla, Ahmed Tahmeed
Dhaka Hospital, International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
J Infect Dev Ctries. 2016 Aug 31;10(8):888-91. doi: 10.3855/jidc.7921.
Streptococcus pneumonia is the most common and intimidating cause of childhood meningitis. Its delayed diagnosis may be associated with hyponatremia and hypernatremia with fatal outcome.
A previously healthy nine-month-old Bangladeshi female infant was diagnosed with diarrhea, pneumonia, and convulsion due to hypernatremia. Pneumonia was confirmed by respiratory distress and radiological findings. Routine cerebrospinal fluid study detected pneumococcal meningitis. Ampicillin, gentamicin, and dexamethasone were promptly started. On day three of hospitalization, convulsion re-appeared with worsening of consciousness level. Antibiotics were switched to ceftriaxone and vancomycin, although ultrasonography of the brain revealed no abnormality. Contrast-enhanced computed tomography scan of the head was performed and revealed dilated ventricles with diffused enhancement of meninges and basal cisterns, demonstrating meningitis with ventriculomegaly. Ceftriaxone was replaced by meropenem to control fever. Magnetic resonance imaging (MRI) of the brain confirmed the progression of hydrocephalus. An emergency ventriculo-peritoneal (VP) shunt operation was performed with continuation of antibiotics for 21 days. After three months, follow-up MRI showed reduction of ventricular size with functioning VP shunt in situ with no neurological deficits.
Childhood pneumococcal meningitis may be associated with diarrhea, pneumonia, and other related complication. Appropriate antibiotic therapy alone may not be sufficient to avert complications. Communicating hydrocephalus is potentially an ominous ramification of meningitis even when the ultrasonography result is normal. Rapid diagnosis is imperative to attain good outcome. Evidence advocates further research into the risk factors of meningitis in diarrheal children that may help in early diagnosis and management to reduce meningitis-related fatal outcome.
肺炎链球菌是儿童脑膜炎最常见且最具威胁性的病因。其诊断延误可能与低钠血症和高钠血症相关，并导致致命后果。
一名此前健康的9个月大孟加拉女婴因高钠血症被诊断出患有腹泻、肺炎和惊厥。通过呼吸窘迫和影像学检查结果确诊为肺炎。常规脑脊液检查发现肺炎球菌性脑膜炎。立即开始使用氨苄西林、庆大霉素和地塞米松进行治疗。住院第三天，惊厥再次出现，意识水平恶化。尽管脑部超声检查未发现异常，但抗生素更换为头孢曲松和万古霉素。进行了头部增强计算机断层扫描，结果显示脑室扩张，脑膜和基底池弥漫性强化，表明患有脑膜炎并伴有脑室扩大。将头孢曲松替换为美罗培南以控制发热。脑部磁共振成像（MRI）证实脑积水病情进展。紧急进行了脑室-腹腔（VP）分流手术，并持续使用抗生素21天。三个月后，随访MRI显示脑室大小减小，VP分流装置在位且功能正常，无神经功能缺损。
儿童肺炎球菌性脑膜炎可能与腹泻、肺炎及其他相关并发症有关。仅采用适当的抗生素治疗可能不足以避免并发症。即使超声检查结果正常，交通性脑积水也可能是脑膜炎的一个不祥后果。快速诊断对于取得良好预后至关重要。有证据支持进一步研究腹泻儿童脑膜炎的危险因素，这可能有助于早期诊断和管理，以降低与脑膜炎相关的致命后果。
