Department of Pediatrics, University of British Columbia.
Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
Pediatr Infect Dis J. 2019 Jun;38(6S Suppl 1):S39-S42. doi: 10.1097/INF.0000000000002313.
Introduction of conjugate vaccines against Haemophilus influenzae type b, Streptococcus pneumoniae, and Neisseria meningitidis has led to a substantial reduction in cases of acute bacterial meningitis in countries with high routine childhood immunization coverage. The majority of children hospitalized with meningitis in high-income countries have viral or aseptic meningitis and do not require antibiotic treatment. Cerebrospinal fluid analysis is irreplaceable in appropriately diagnosing and treating bacterial meningitis and avoiding unnecessary antibiotics and prolonged hospitalizations in children with viral meningitis. New diagnostic tests have improved detection of bacterial and viral pathogens in cerebrospinal fluid, underscoring the importance of promptly performing lumbar puncture when meningitis is suspected. This article provides an overview of acute bacterial and viral meningitis in children, focusing on the changing epidemiology, the advantages and limitations of conventional and newer diagnostic methods, and considerations for clinical practice.
引言
针对流感嗜血杆菌、肺炎链球菌和脑膜炎奈瑟菌的结合疫苗的引入，使得高常规儿童免疫接种覆盖率国家的急性细菌性脑膜炎病例大量减少。在高收入国家，大多数因脑膜炎住院的儿童患有病毒性或无菌性脑膜炎，不需要抗生素治疗。脑脊液分析在适当诊断和治疗细菌性脑膜炎以及避免病毒性脑膜炎儿童不必要的抗生素和延长住院时间方面是不可替代的。新的诊断检测方法提高了脑脊液中细菌和病毒病原体的检测能力，强调了在怀疑发生脑膜炎时及时进行腰椎穿刺的重要性。本文概述了儿童急性细菌性和病毒性脑膜炎，重点介绍了不断变化的流行病学、传统和新型诊断方法的优缺点以及临床实践中的注意事项。
