Zhang Y, Song L Z, Liu G F, Li M S, Lin X J, Xu A Q
Division of Expanded Immunization Program, Shandong Center for Disease Control and Prevention; Academy of Preventive Medicine, Shandong University; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Jinan 250014, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2019 Feb 6;53(2):169-173. doi: 10.3760/cma.j.issn.0253-9624.2019.02.009.
To analyze epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases. Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of AMES (acute meningitis/encephalitis syndrome) cases were collected in the six sentinel hospitals from 2007 to 2016. () species and serogroup identification were detected by the methods of real-time fluorescent quantitative polymerase chain reaction (Real-time PCR) and bacterial culture, and epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases were analyzed. 6 809 AMES cases were reported from 2007 to 2016. Total 4 422 cases were detected, and 90 cases were positive. Through the methods of Real-time PCR, bacterial blood culture and CSF culture, the numbers of positive cases were 90, 2 and 1 respectively. Twenty-two cases were identified from 2007 to 2011 (4 cases were ungrouped), which with the highest incidence in serogroup C cases (17/18), and one cases was ungroupable . laboratory confirmed cases (68 cases) were increased dramatically and mainly occurred in serogroup B cases (43/67, 64.2%) from 2012 to 2016, with serogroup C cases highly decreased (5/67, 7.5%) and ungroupable cases increased (13/67, 19.4%) meanwhile. Serogroup W135 and X cases were first detected at 2012 and 2014, and serogroup A remaining a low level which only detected one case at 2013. The morbidity of epidemic cerebrospinal meningitis was occured in the whole year, and mainly in winter and spring. The ratio of laboratory confirmed cases to AMES cases during November to May (3.5%, 67/1 920) was higher than that during June to October (0.9%, 23/2 502) (χ(2)=34.45, 0.001). Most cases were children, students and farmers, and account for 30.0% (27/90), 31.1% (28/90), 18.9% (17/90), respectively. The majority of cases were under 20 years old (60/90, 66.67%), and serogroup C cases (17/22, 77.3%) mainly occurred in over 12 years old population, while serogroup B (24/43, 55.8%) and ungroupable (6/14) cases mainly occurred in under 12 years old population. The main clinical symptoms of epidemic cerebrospinal meningitis cases were fever (78/90, 86.7%), headache (59/90, 65.6%) and vomiting (51/90, 56.7%). Misdiagnosis rate of admitting diagnosis was up to 87.8% (79/90) for the reason of atypical features in specific symptoms and blood or CSF positive index. The well-healed ratio in correct diagnosed group (7/11) was higher than that in misdiagnosed group (2.5%, 2/79) (χ(2)=40.61, 0.001). The clinical symptoms of epidemic cerebrospinal meningitis cases were atypical, and the diagnosed sensitivity and accuracy would be improved by enhanced molecular biology detection. The predominant epidemic serogroup of switched from serogroup C to B, and the key work was surveaylance of serogroup transition.
分析实验室确诊的流行性脑脊髓膜炎病例的流行病学和临床特征。2007年至2016年期间，在六家哨点医院收集急性脑膜炎/脑炎综合征（AMES）病例的流行病学和临床信息以及脑脊液（CSF）和血液标本。通过实时荧光定量聚合酶链反应（Real-time PCR）和细菌培养方法进行（）菌种和血清群鉴定，并分析实验室确诊的流行性脑脊髓膜炎病例的流行病学和临床特征。2007年至2016年共报告6809例AMES病例。共检测4422例，其中90例呈阳性。通过Real-time PCR、细菌血培养和脑脊液培养方法，阳性病例数分别为90例、2例和1例。2007年至2011年共鉴定出22例（4例未分型），其中C群病例发病率最高（17/18），1例无法分型。2012年至2016年实验室确诊病例（68例）大幅增加，主要发生在B群病例（43/67，64.2%），同时C群病例大幅下降（5/67，7.5%），无法分型病例增加（13/67，19.4%）。W135群和X群病例分别于2012年和2014年首次检测到，A群维持在低水平，仅在2013年检测到1例。流行性脑脊髓膜炎全年发病，主要集中在冬春季。11月至5月实验室确诊病例与AMES病例的比例（3.5%，67/1920）高于6月至10月至10月（0.9%，23/2502）（χ(2)=34.45，P<0.001）。多数病例为儿童、学生和农民，分别占30.0%（27/90）、31.1%（28/90）、18.9%（17/90）。多数病例年龄在20岁以下（60/90，66.67%），C群病例（17/22，77.3%）主要发生在12岁以上人群，而B群（24/43，55.8%）和无法分型（6/14）病例主要发生在12岁以下人群。流行性脑脊髓膜炎病例的主要临床症状为发热（78/90，86.7%）、头痛（59/90，65.6%）和呕吐（51/90，56.7%）。由于特定症状、血液或脑脊液阳性指标不典型，入院诊断误诊率高达87.8%（79/90）。正确诊断组的痊愈率（7/11）高于误诊组（2.5%，2/79）（χ(2)=40.61，P<0.001）。流行性脑脊髓膜炎病例临床症状不典型，加强分子生物学检测可提高诊断的敏感性和准确性。流行优势血清群由C群转为B群，关键工作是监测血清群变迁。
