Hénaff Fanny, Levy Corinne, Cohen Robert, Picard Capucine, Varon Emmanuelle, Gras Le Guen Christèle, Launay Elise
From the *Urgences pédiatriques, CHU Nantes, Hôpital Mère-Enfant, 44093 Nantes, France; †ACTIV, Association Clinique et Thérapeutique Infantile du Val de Marne, 94100 Saint-Maur des Fossés, France; ‡Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; §Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, 94000 Créteil, France; ¶Laboratoire de génétique humaine des maladies infectieuses, institut national de la santé et de la recherche médicale, UMR1163, Institut IMAGINE, 75015 Paris, France; ‖Faculté de médecine de Necker, Université Paris V René-Descartes, 75015 Paris, France; **Centre d'études des déficits immunitaires (CEDI), AP-HP, hôpital Necker-Enfants-Malades, 75015 Paris, France; ††Centre National de Référence des Pneumocoques, AP-HP, HEGP (Hôpital Européen Georges Pompidou), Université Paris V, 75006 Paris, France; and ‡‡Pédiatrie générale, CHU Nantes, Hôpital Mère-Enfant, 44093 Nantes, France.
Pediatr Infect Dis J. 2017 May;36(5):457-461. doi: 10.1097/INF.0000000000001470.
The occurrence of meningitis in children >5 years old may be associated with specific predisposing factors that can be anatomic, such as cerebrospinal fluid fistula or breach, or related to genetic susceptibility or N inborn or acquired immunologic defect. This study aimed to assess the anatomical and immunologic risk factors in children >5 years old with pneumococcal meningitis and prospectively enrolled in the French national meningitis network.
We analyzed all data for children who were 5-15 years old with a diagnosis of pneumococcal meningitis between 2001 and 2013. We describe the frequency and typology of the anatomic or immunologic risk factors, the clinical features and the pneumococcal serotypes.
Among the 316 patients with pneumococcal meningitis, the mortality rate was 9.5% and 23.1% of cases presented complications (abscess, coma, hemodynamic failure, thrombophlebitis cerebral or deafness). In total, 108 children (34%) showed risk factors, the most frequent being anatomic: 70 cases (22.8%) were related to a cerebrospinal fluid breach or fistula and 55 (17.9%) to immunodeficiency, primary or acquired. Serotype data were available for 207 pneumococcal isolates (65.5%). The most frequent serotypes were as follows: 3, 18C, 19A and 19F between 2001 and 2009 and 19F, 3, 19A, 12F, 22F, 17F and 24F after 2009.
We describe the largest cohort of children >5 years old with pneumococcal meningitis. One third of the children had risk factors justifying a complete immunologic and radiologic work-up.
5岁以上儿童发生脑膜炎可能与特定的易感因素有关，这些因素可以是解剖学上的，如脑脊液瘘或破裂，也可能与遗传易感性或先天性或获得性免疫缺陷有关。本研究旨在评估5岁以上患肺炎球菌性脑膜炎并前瞻性纳入法国国家脑膜炎网络的儿童的解剖学和免疫危险因素。
我们分析了2001年至2013年间5至15岁诊断为肺炎球菌性脑膜炎的儿童的所有数据。我们描述了解剖学或免疫危险因素的频率和类型、临床特征及肺炎球菌血清型。
在316例肺炎球菌性脑膜炎患者中，死亡率为9.5%，23.1%的病例出现并发症（脓肿、昏迷、血流动力学衰竭、脑静脉血栓形成或耳聋）。共有108名儿童（34%）显示出危险因素，最常见的是解剖学因素：70例（22.8%）与脑脊液破裂或瘘有关，55例（17.9%）与原发性或获得性免疫缺陷有关。207株肺炎球菌分离株（65.5%）有血清型数据。最常见的血清型如下：2001年至2009年为3型、18C型、19A型和19F型，2009年后为19F型、3型、19A型、12F型、22F型、17F型和24F型。
我们描述了最大规模的5岁以上肺炎球菌性脑膜炎儿童队列。三分之一的儿童有危险因素，需要进行全面的免疫学和放射学检查。
