Gofrit Shany Guly, Pikkel Yoav Yechezkel, Levine Hagai, Fraifeld Shifra, Kahana Merhavi Shlomzion, Friedensohn Limor, Eliahou Ruth, Ben-Hur Tamir, Honig Asaf
Medical Corps of the Israel Defense Forces, Haifa, Israel.
Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel.
Front Neurol. 2022 Jun 30;13:887677. doi: 10.3389/fneur.2022.887677. eCollection 2022.
Meningitis and meningoencephalitis (MME) are potential medical emergencies. Mandatory reporting of all MME cases in the Israel Defense Force (IDF) allows accurate characterization of MME incidence and course. In the present study, we described the epidemiology of MME in soldiers.
Medical charts of 860,000 combat and non-combat soldiers serving during the years 2004-2015, accounting for 2,256,060 patient years, were retrospectively evaluated. The diagnosis of MME was based on signs of meningeal irritation and a count of > 5 white blood cells (WBC) in the cerebrospinal fluid (CSF). Data on the diagnosis of bacterial or aseptic MME, significant sequelae, and associated mortality were collected.
Approximately 273 cases of MME were diagnosed. Overall, MME incidence was 12.1/100,000 patient-years. Bacterial and viral pathogens were identified in 31/273 (11.4%) and 52/273 (19%) cases, respectively. Combat soldiers had higher incidence of bacterial meningitis [14/40 (35%) vs. 31/212 (14.6%); = 0.002] and meningoencephalitis [13/40 (32.5%) vs. 33/212 (15.6%); = 0.023] compared to non-combat soldiers. Their clinical presentation was more severe, including confusion [10/40 (25%) vs. 22/212 (10.4%); = 0.018], focal neurological deficits [12/40 (30%) vs. 11/212 (5.2%); < 0.0001], and status epilepticus [3/40 (7.5%) vs. 0/212 (0.0%); < 0.01]. Mortality among combat soldiers was higher [5/40 (15%) vs. 1/212 (0.5%); < 0.001]. was the most frequently isolated bacteria, despite universal preventative vaccination.
The incidence of bacterial MME in the IDF is higher than in the civilian population. Combat soldiers present with higher incidence of meningoencephalitis and bacterial meningitis.
脑膜炎和脑膜脑炎（MME）是潜在的医疗急症。对以色列国防军（IDF）所有MME病例进行强制报告，有助于准确描述MME的发病率和病程。在本研究中，我们描述了士兵中MME的流行病学情况。
回顾性评估了2004年至2015年期间服役的860,000名作战和非作战士兵的病历，共计2,256,060人年。MME的诊断基于脑膜刺激征和脑脊液（CSF）中白细胞（WBC）计数>5个。收集了关于细菌性或无菌性MME诊断、严重后遗症及相关死亡率的数据。
共诊断出约273例MME。总体而言，MME发病率为12.1/100,000人年。分别在31/273（占11.4%）和5,2/273（占19%）的病例中鉴定出细菌和病毒病原体。与非作战士兵相比，作战士兵细菌性脑膜炎的发病率更高[14/40（35%）对31/212（14.6%）；P = 0.002]，脑膜脑炎的发病率也更高[13/40（32.5%）对33/212（15.6%）；P = 0.023]。他们的临床表现更严重，包括意识模糊[10/40（25%）对22/212（10.4%）；P = 0.018]、局灶性神经功能缺损[12/40（30%）对11/212（5.2%）；P < 0.0001]和癫痫持续状态[3/40（7.5%）对0/212（0.0%）；P < 0.01]。作战士兵的死亡率更高[5/40（15%）对1/212（0.5%）；P < 0.001]。尽管进行了普遍的预防性疫苗接种，但肺炎链球菌是最常分离出的细菌。
IDF中细菌性MME的发病率高于平民。作战士兵脑膜脑炎和细菌性脑膜炎的发病率更高。
