Zhang Y, Li M S, Liu G F, Song L Z, Zhang L, 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):179-184. doi: 10.3760/cma.j.issn.0253-9624.2019.02.011.
To analyze epidemiological characteristics of acute bacterial meningitis (ABM) cases and the common pathogens infected in Jinan, Shandong Province. Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of acute meningitis/encephalitis syndrome (AMES) cases (total 3 918 cases) were collected in the six sentinel hospitals from 2013 to 2016. , and were detected by the methods of real-time fluorescent quantitative polymerase chain reaction (Real-time PCR), bacterial culture and latex agglutination. χ(2) test was used to compare ABM cases with different feasures, and compare the difference of and cases in clinical and epidemiological characteristics. A total of 479 cases were diagnosed as ABM from 2013 to 2016, 82 cases of which were laboratory confirmed, including 54 cases infected with , 25 cases infected with , and 3 cases infected with . The disease course in different age groups of ABM cases has statistically difference (χ(2)=40.95, 0.001). The disease course of under 6 (63.6%, 161/253) and 7 to 17 (55.9%, 33/59) years old ABM cases mainly required 14-28 days, and over 18 years old cases mainly required less than 14 days (59.9%, 100/167). For cases, there was a main onset period from October to March (75.9%, 41/54); on the disease course, under 6 (81.0%, 17/21) and 7 to 17 (16/18) years old cases mainly required less than 14 days, while over 18 years old cases mainly required 14-28 days (8/15), and there was a statistically difference in different age groups (χ(2)=8.44, 0.015). For cases, the major onset period was from December to May (84.0%, 21/25); on the disease course, all of under 6 and 7 to 17 years old cases were required 14-28 days, while over 18 years old cases mainly required less than 14 days (9/17), and there was a statistically difference in different age groups (χ(2)=6.62, 0.037). 91.0% of the ABM cases (436/479) were healed or improvement, with the relatively higher ratio in under 6 (94.9%, 240/253) and 7 to 17 (98.3%, 58/59) years old groups, and poorer ratio in over 18 years old group (82.6%, 138/167), and the difference was significant in different age groups (χ(2)=22.77, 0.001). and cases, the ratio of cases that were healed or improvement were 87.0% (47/54), 92.0% (23/25) and 3/3, respectively, and there were no death cases. ABM cases were found mostly in under 18 years old group in Jinan, Shandong Province, and the bigger age group had poor prognosis. was the major pathogen causing ABM, followed by and . Distinguished differences of epidemiological characteristics were found on ABM cases suffered with different pathogens infected.
分析山东省济南市急性细菌性脑膜炎（ABM）病例的流行病学特征及感染的常见病原体。收集2013年至2016年6家哨点医院急性脑膜炎/脑炎综合征（AMES）病例（共3918例）的流行病学和临床资料以及脑脊液（CSF）和血液标本，采用实时荧光定量聚合酶链反应（Real-time PCR）、细菌培养和乳胶凝集法进行检测。采用χ²检验比较不同特征的ABM病例，并比较不同病原体感染病例在临床和流行病学特征上的差异。2013年至2016年共诊断出479例ABM病例，其中82例经实验室确诊，包括54例感染肺炎链球菌、25例感染脑膜炎奈瑟菌、3例感染B组链球菌。ABM病例不同年龄组的病程有统计学差异（χ² = 40.95，P < 0.001）。6岁以下（63.6%，161/253）和7至17岁（55.9%，33/59）的ABM病例病程主要为14 - 28天，18岁以上病例病程主要为少于14天（59.9%，100/167）。对于肺炎链球菌感染病例，主要发病期为10月至3月（75.9%，41/54）；在病程方面，6岁以下（81.0%，17/21）和7至17岁（16/18）病例病程主要为少于14天，而18岁以上病例病程主要为14 - 28天（8/15），不同年龄组有统计学差异（χ² = 8.44，P = 0.015）。对于脑膜炎奈瑟菌感染病例，主要发病期为12月至5月（84.0%，21/25）；在病程方面，6岁以下和7至17岁病例病程均为14 - 28天，而18岁以上病例病程主要为少于14天（9/17），不同年龄组有统计学差异（χ² = 6.62，P = 0.037）。91.0%的ABM病例（436/479）治愈或好转，6岁以下（94.9%，240/253）和7至17岁（98.3%，58/59）组比例相对较高，18岁以上组比例较低（82.6%，138/167），不同年龄组差异有统计学意义（χ² = 22.77，P < 0.001）。肺炎链球菌和脑膜炎奈瑟菌感染病例治愈或好转的比例分别为87.0%（47/54）、92.0%（23/25）和3/3，且无死亡病例。山东省济南市ABM病例多见于18岁以下人群，年龄较大组预后较差。肺炎链球菌是引起ABM的主要病原体，其次是脑膜炎奈瑟菌和B组链球菌。不同病原体感染的ABM病例在流行病学特征上存在明显差异。
