安哥拉罗安达 90 天以下婴儿细菌性脑膜炎的临床和脑脊液指标诊断准确性。

Accuracy of Clinical and Cerebrospinal Fluid Indicators in the Diagnosis of Bacterial Meningitis in Infants <90 Days of Age in Luanda, Angola.

机构信息

From the Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Hospital Pediátrico David Bernardino (HPDB), Luanda, Angola.

出版信息

Pediatr Infect Dis J. 2021 Dec 1;40(12):e462-e465. doi: 10.1097/INF.0000000000003305.

DOI:10.1097/INF.0000000000003305

PMID:34561386

Abstract

BACKGROUND

The diagnosis of bacterial meningitis (BM) is problematic in young infants, as clinical features may be nonspecific or even absent. Cerebrospinal fluid (CSF) analysis usually confirms the diagnosis, but the CSF parameters can be normal also in culture-proven BM. Our objective was to identify the clinical and CSF indices, that quickly and without laboratory likely lead to the diagnosis of confirmed of probable BM in young infants in Angola.

METHODS

We conducted a prospective, observational, single-site study from February 2016 to October 2017 in the Pediatric Hospital of Luanda. All assessed infants showed symptoms and signs compatible of BM or neonatal sepsis and were <90 days of age.

RESULTS

Of the 1088 infants, 212 (19%) showed bacteria in CSF, while 88 (8%) had probable BM. Independent clinical indicators of BM were not-clear CSF, seizures, weight <2500 g and illness >7 days. In infants with BM, CSF leukocytes were >10 × 106/L in 46%, CSF glucose <25 mg/dL in 43% and CSF protein >120 mg/dL in 58%. All measured parameters were in normal range in 25% of patients. In 515 infants with normal CSF parameters, bacteria were found in 74 (14%). In these infants, illness >7 days, weight <2500 g and malnutrition increased the probability of BM.

CONCLUSIONS

Our study confirms and underlines the problems in diagnosing BM in young infants. While the CSF parameters were normal in 25% of infants, the easily recognizable unclear appearance of CSF was the single strongest predictor of BM.

摘要

背景

细菌性脑膜炎（BM）的诊断在婴幼儿中存在问题，因为临床特征可能不明确甚至不存在。脑脊液（CSF）分析通常可确诊，但即使在培养阳性的 BM 中，CSF 参数也可能正常。我们的目的是确定在安哥拉，能够快速且无需实验室检查就可诊断明确或可能的 BM 的临床和 CSF 指标。

方法

我们于 2016 年 2 月至 2017 年 10 月在罗安达儿科医院进行了一项前瞻性、观察性、单站点研究。所有评估的婴儿均表现出与 BM 或新生儿败血症相符的症状和体征，且年龄<90 天。

结果

在 1088 名婴儿中，212 名（19%）CSF 中有细菌，88 名（8%）有疑似 BM。BM 的独立临床指标包括 CSF 不清晰、惊厥、体重<2500g 和疾病持续>7 天。在有 BM 的婴儿中，CSF 白细胞>10×106/L 占 46%，CSF 葡萄糖<25mg/dL 占 43%，CSF 蛋白>120mg/dL 占 58%。所有测量的参数在 25%的患者中均在正常范围内。在 515 名 CSF 指标正常的婴儿中，有 74 名（14%）发现细菌。在这些婴儿中，疾病持续>7 天、体重<2500g 和营养不良增加了 BM 的可能性。