Valmari P, Palva A
Infection. 1986 Jan-Feb;14(1):36-7. doi: 10.1007/BF01644809.
An eight-year-old boy with a congenital inner ear malformation and recurrent otitis media had three episodes of bacteriologically confirmed meningitis within seven months. The first episode was caused by pneumococci, the other two by non-typable Haemophilus influenzae. All episodes were characterized by an abrupt onset. The CSF cultures were positive within 0.5 to 12 hours after the onset of symptoms. Despite misleading laboratory studies, surgical exploration revealed a CSF fistula associated to the inner ear anomaly. No further episodes occurred after the fistula was closed. Careful roentgenographic evaluation, including recently introduced special computed tomography (CT) methods, is indicated in recurrent meningitis. In addition, such evaluations should be considered even after the first episode, when special clinical features suggest a CSF fistula. Such features include an extremely rapid onset and detection of common non-invasive bacteria as causative agents, as illustrated by the present case.
一名患有先天性内耳畸形和复发性中耳炎的8岁男孩在7个月内发生了3次经细菌学证实的脑膜炎。第一次发作由肺炎球菌引起，另外两次由不可分型流感嗜血杆菌引起。所有发作均以突然起病为特征。脑脊液培养在症状出现后0.5至12小时内呈阳性。尽管实验室检查结果有误导性，但手术探查发现了与内耳异常相关的脑脊液瘘。瘘管闭合后未再出现发作。对于复发性脑膜炎，需要进行仔细的影像学评估，包括最近引入的特殊计算机断层扫描（CT）方法。此外，即使在首次发作后，如果特殊的临床特征提示存在脑脊液瘘，也应考虑进行此类评估。这些特征包括起病极快以及检测到常见的非侵袭性细菌作为病原体，本病例即说明了这一点。
