成人复发性社区获得性细菌性脑膜炎。
Recurrent Community-Acquired Bacterial Meningitis in Adults.
机构信息
Amsterdam UMC, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands; Amsterdam University Medical Centers, University of Amsterdam.
Amsterdam University Medical Centers, University of Amsterdam, Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Meibergdreef, Amsterdam, The Netherlands.
出版信息
Clin Infect Dis. 2021 Nov 2;73(9):e2545-e2551. doi: 10.1093/cid/ciaa1623.
BACKGROUND
Recurrent bacterial meningitis has been found to occur in about 5% of meningitis cases.
METHODS
We analyzed adults with recurrent episodes in a prospective nationwide cohort study of community-acquired bacterial meningitis.
RESULTS
Of 2264 episodes of community-acquired bacterial meningitis between 2006 and 2018, 143 (6%) were identified as recurrent episodes in 123 patients. The median age was 57 years (interquartile range [IQR], 43-66), and 57 episodes (46%) occurred in men. The median duration between the first and the current episode was 5 years (IQR, 1-15). For 82 of 123 patients (67%), it was the first recurrent episode, 31 patients had 2-5 previous episodes (25%), 2 had 6-10 episodes (2%), and 2 had >10 episodes (2%). Predisposing factors were identified in 87 of 118 patients (74%) and most commonly consisted of ear or sinus infections (43 of 120, 36%) and cerebrospinal fluid leakage (37 of 116, 32%). The most common pathogens were Streptococcus pneumoniae (93 of 143, 65%) and Haemophilus influenzae (19 of 143, 13%). The outcome was unfavorable (Glasgow outcome scale score, <5) in 24 episodes with recurrent meningitis (17%) vs 810 for nonrecurrent meningitis patients (39%, P < .001). Six of 143 died (4%) vs 362 of 2095 patients (17%, P < .001).
CONCLUSIONS
Recurrent meningitis occurs mainly in patients with ear or sinus infections and cerebrospinal fluid leakage. Predominant causative pathogens are S. pneumoniae and H. influenzae. The disease course is less severe, resulting in lower case fatality compared with nonrecurrent meningitis patients.
背景
复发性细菌性脑膜炎的发生率约为 5%。
方法
我们对 2006 年至 2018 年期间发生的社区获得性细菌性脑膜炎前瞻性全国队列研究中的复发性发作患者进行了分析。
结果
在 2264 例社区获得性细菌性脑膜炎发作中，有 143 例（6%）在 123 例患者中被确定为复发性发作。中位年龄为 57 岁（四分位距[IQR]，43-66），57 例（46%）发生于男性。首次发作与当前发作之间的中位时间为 5 年（IQR，1-15）。123 例患者中，82 例（67%）为首次复发性发作，31 例（25%）有 2-5 次既往发作，2 例（2%）有 6-10 次发作，2 例（2%）有>10 次发作。118 例患者中有 87 例（74%）确定了易患因素，最常见的因素包括耳部或鼻窦感染（120 例中的 43 例，36%）和脑脊液漏（116 例中的 37 例，32%）。最常见的病原体是肺炎链球菌（143 例中的 93 例，65%）和流感嗜血杆菌（143 例中的 19 例，13%）。复发性脑膜炎患者的预后不良（Glasgow 结局量表评分，<5）有 24 例（17%），而非复发性脑膜炎患者为 810 例（39%，P<.001）。143 例患者中有 6 例（4%）死亡，2095 例患者中有 362 例（17%，P<.001）。
结论
复发性脑膜炎主要发生于耳部或鼻窦感染和脑脊液漏患者。主要病原体为肺炎链球菌和流感嗜血杆菌。与非复发性脑膜炎患者相比，其病程较轻，病死率较低。
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