柬埔寨住院儿童中枢神经系统感染的病因。
The aetiologies of central nervous system infections in hospitalised Cambodian children.
机构信息
Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia.
Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
出版信息
BMC Infect Dis. 2017 Dec 29;17(1):806. doi: 10.1186/s12879-017-2915-6.
BACKGROUND
Central nervous system (CNS) infections are an important cause of childhood morbidity and mortality. The aetiologies of these potentially vaccine-preventable infections have not been well established in Cambodia.
METHODS
We did a one year prospective study of children hospitalised with suspected CNS infection at Angkor Hospital for Children, Siem Reap. Cerebrospinal fluid specimens (CSF) samples underwent culture, multiplex PCR and serological analysis to identify a range of bacterial and viral pathogens. Viral metagenomics was performed on a subset of pathogen negative specimens.
RESULTS
Between 1st October 2014 and 30th September 2015, 284 analysable patients were enrolled. The median patient age was 2.6 years; 62.0% were aged <5 years. CSF white blood cell count was ≥10 cells/μL in 116/272 (42.6%) cases. CNS infection was microbiologically confirmed in 55 children (19.3%). Enteroviruses (21/55), Japanese encephalitis virus (17/55), and Streptococcus pneumoniae (7/55) accounted for 45 (81.8%) of all pathogens identified. Of the pathogens detected, 74.5% (41/55) were viruses and 23.6% (13/55) were bacteria. The majority of patients were treated with ceftriaxone empirically. The case fatality rate was 2.5%.
CONCLUSIONS
Enteroviruses, JEV and S. pneumoniae are the most frequently detected causes of CNS infection in hospitalised Cambodian children.
背景
中枢神经系统（CNS）感染是儿童发病率和死亡率的重要原因。这些潜在可通过疫苗预防的感染的病因在柬埔寨尚未得到很好的确定。
方法
我们对在暹粒的吴哥窟儿童医院因疑似 CNS 感染住院的儿童进行了为期一年的前瞻性研究。脑脊液（CSF）标本进行了培养、多重 PCR 和血清学分析，以确定一系列细菌和病毒病原体。对部分病原体阴性标本进行了病毒宏基因组学检测。
结果
2014 年 10 月 1 日至 2015 年 9 月 30 日期间，共纳入 284 例可分析患者。中位患者年龄为 2.6 岁；62.0%的患者年龄<5 岁。272 例 CSF 白细胞计数≥10 个/μL 的患者中，116 例（42.6%）。55 例儿童 CNS 感染得到了微生物学证实。肠道病毒（21/55）、日本脑炎病毒（17/55）和肺炎链球菌（7/55）占所有鉴定病原体的 45.0%（81.8%）。在所检测的病原体中，74.5%（41/55）为病毒，23.6%（13/55）为细菌。大多数患者接受了头孢曲松经验性治疗。病死率为 2.5%。
结论
肠道病毒、JEV 和肺炎链球菌是柬埔寨住院儿童 CNS 感染最常检测到的病原体。
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