Shukla Bhavarth, Aguilera Elizabeth A, Salazar Lucrecia, Wootton Susan H, Kaewpoowat Quanhathai, Hasbun Rodrigo
Division of Infectious Diseases, Department of Internal Medicine, University of Texas (UT) Health Science Center, Houston, TX, USA.
Division of Infectious Diseases, Department of Pediatrics, University of Texas (UT) Health Science Center, Houston, TX, USA.
J Clin Virol. 2017 Sep;94:110-114. doi: 10.1016/j.jcv.2017.07.016. Epub 2017 Aug 4.
Aseptic meningitis represents a common diagnostic and management dilemma to clinicians.
To compare the clinical epidemiology, diagnostic evaluations, management, and outcomes between adults and children with aseptic meningitis.
We conducted a retrospective study from January 2005 through September 2010 at 9 Memorial Hermann Hospitals in Houston, TX. Patients age≥2months who presented with community-acquired aseptic meningitis with a CSF white blood cell count >5cells/mm and a negative Gram stain and cultures were enrolled. Patients with a positive cryptococcal antigen, positive blood cultures, intracranial masses, brain abscesses, or encephalitis were excluded.
A total of 509 patients were included; 404 were adults and 105 were children. Adults were most likely to be female, Caucasian, immunosuppressed, have meningeal symptoms (headache, nausea, stiff neck, photophobia) and have a higher CSF protein (P <0.05). In contrast, children were more likely to have respiratory symptoms, fever, and leukocytosis (P <0.05). In 410 (81%) patients, the etiologies remained unknown. Adults were more likely to be tested for and to have Herpes simplex virus and West Nile virus while children were more likely to be tested for and to have Enterovirus (P <0.001). The majority of patients were admitted (96.5%) with children receiving antibiotic therapy more frequently (P <0.001) and adults receiving more antiviral therapy (P=0.001). A total of 384 patients (75%) underwent head CT scans and 125 (25%) MRI scans; all were normal except for meningeal enhancement. All patients had a good clinical outcome at discharge.
Aseptic meningitis in adults and children represent a management challenge as etiologies remained unknown for the majority of patients due to underutilization of currently available diagnostic techniques.
无菌性脑膜炎给临床医生带来了常见的诊断和管理难题。
比较成人和儿童无菌性脑膜炎的临床流行病学、诊断评估、管理及预后。
我们于2005年1月至2010年9月在德克萨斯州休斯顿的9家纪念赫尔曼医院进行了一项回顾性研究。纳入年龄≥2个月、患有社区获得性无菌性脑膜炎、脑脊液白细胞计数>5个/立方毫米且革兰氏染色和培养结果为阴性的患者。排除隐球菌抗原阳性、血培养阳性、颅内肿块、脑脓肿或脑炎患者。
共纳入509例患者；404例为成人，105例为儿童。成人最常见于女性、白种人、免疫抑制患者，有脑膜症状（头痛、恶心、颈部僵硬、畏光）且脑脊液蛋白较高（P<0.05）。相比之下，儿童更易出现呼吸道症状、发热和白细胞增多（P<0.05）。410例（81%）患者病因仍不明。成人更有可能接受单纯疱疹病毒和西尼罗河病毒检测且感染这些病毒，而儿童更有可能接受肠道病毒检测且感染肠道病毒（P<0.001）。大多数患者入院（96.5%），儿童更频繁接受抗生素治疗（P<0.001），成人接受更多抗病毒治疗（P=0.001）。共有384例患者（75%）接受了头部CT扫描，125例（25%）接受了MRI扫描；除脑膜强化外均正常。所有患者出院时临床预后良好。
成人和儿童无菌性脑膜炎是一个管理挑战，因为由于当前可用诊断技术利用不足，大多数患者病因仍不明。
