Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam.
IHU-Méditerranée Infection, Marseille, France.
Emerg Microbes Infect. 2022 Dec;11(1):1683-1692. doi: 10.1080/22221751.2022.2088405.
From July to October 2020, 99 cases of central nervous system (CNS) infections were identified in Thai Binh Pediatric Hospital, Viet Nam, representing a five-fold increase compared to the baseline incidence during the previous five years. Clinical data were retrospectively collected. Cerebrospinal fluid specimens (CSF) were secondarily tested for pathogens using viral culture and PCR assays. Patient median age was 5 years (0-12 years); 58.6% were male. Of these children, 83.8% had CSF white blood culture (WBC) counts of ≥ 10 cells/µL, including 58 of 99 (58.6%) with a WBC count ≥ 100 cells/µL. Overall, 72 (72.7%) patients had confirmed infections with a pathogen identified in the CSF, the majority of which (66) were enterovirus. Sequencing results suggested that the rise of incidence observed in 2020 was due to Echovirus 4 ( = 45), Echovirus 30 ( = 8), and Echovirus 6 (= 1) circulation. A confirmed CNS infection was significantly associated with older age (≥5 years, OR = 3.64, = 0.03) and with an increased WBC count in the CSF (OR = 6.38, -value = 0.01 for WBCs from 10 to <100 and OR = 7.90, -value = 0.002 for WBCs ≥100). Ninety-seven (97) of 99 (98.0%) children received empiric antimicrobial treatment, and 35 (35.3%) were treated with multiple antibiotics. Eighty-four (84) patients (84.9%) were discharged home, and 11 (11.1%) were transferred to the National Hospital because their condition had worsened. No deaths were recorded. Point-of-care tests, including real-time PCR assays to identify common pathogens, should be implemented for more accurate diagnosis and more appropriate antibiotic use.
2020 年 7 月至 10 月，越南太平儿童医院共发现 99 例中枢神经系统（CNS）感染病例，与前五年的基线发病率相比增加了五倍。本研究回顾性收集了临床数据，并采用病毒培养和 PCR 检测对脑脊液（CSF）标本进行了二次病原体检测。患者中位年龄为 5 岁（0-12 岁）；58.6%为男性。这些儿童中，83.8%的 CSF 白细胞（WBC）计数≥10 个/µL，其中 99 例中的 58 例（58.6%）WBC 计数≥100 个/µL。总体而言，72 例（72.7%）患者 CSF 中明确有病原体感染，其中大多数（66 例）为肠道病毒。测序结果表明，2020 年发病率上升归因于埃可病毒 4（ = 45）、埃可病毒 30（ = 8）和埃可病毒 6（ = 1）的流行。确诊的 CNS 感染与年龄较大（≥5 岁，OR = 3.64， = 0.03）和 CSF 中白细胞计数增加（OR = 6.38，-值 = 0.01，白细胞计数为 10-<100；OR = 7.90，-值 = 0.002，白细胞计数≥100）显著相关。99 例中的 97 例（97.9%）儿童接受了经验性抗菌治疗，35 例（35.3%）接受了多种抗生素治疗。84 例（84.9%）患者出院回家，11 例（11.1%）因病情恶化转至国家医院。无死亡病例。应实施即时检测，包括实时 PCR 检测以识别常见病原体，以进行更准确的诊断和更恰当的抗生素使用。
