Katharine M. Cooley was an Epidemiologist, Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO.
Shannon Fleck-Derderian, MPH, is an Epidemiologist, Division of Vector-Borne Diseases, US Centers for Disease Control and Prevention, Fort Collins, CO.
Health Secur. 2023 Jan-Feb;21(1):22-33. doi: 10.1089/hs.2022.0081. Epub 2022 Dec 20.
Plague meningitis is a serious and often fatal manifestation of infection. In the aftermath of a bioweapon attack with , this typically rare manifestation may develop in a substantial number of patients, particularly if treatment delays occur. Risk factors, clinical evolution, and optimal treatment strategies for plague meningitis are not well understood. We searched PubMed Central and other databases for reports of plague meningitis in any language. Articles containing descriptions of patients with plague meningitis and their treatment and outcomes were included. Among 1,496 articles identified in our search, 56 articles describing 84 cases from 1898 to 2015 met inclusion criteria. The median age of patients was 16 years (range 6 weeks to 64 years); 68% were male. Most patients (n = 50, 60%) developed meningitis following primary bubonic plague. Common signs and symptoms included fever (n = 56, 66%), nuchal rigidity (n = 38, 45%), and headache (n = 33, 36%); 29% (n = 24) of patients had focal neurologic deficits such as cranial nerve abnormalities. Almost all (n = 23, 96%) of the 24 patients who did not receive antimicrobials died, and 42% (n = 25) of the 59 patients treated with antimicrobials died. The case fatality rate of patients grouped by antimicrobial received was 50% (1 out of 2) for fluoroquinolones, 19% (4 out of 21) for aminoglycosides, 14% (2 out of 14) for sulfonamides, 11% (2 out of 18) for chloramphenicol, and 0% (0 out of 13) for tetracyclines. Plague meningitis most often occurs as a complication of bubonic plague and can cause focal neurologic deficits. Survival is more likely in patients who receive antimicrobials; tetracyclines, aminoglycosides, and chloramphenicol had the lowest associated case fatality rates.
plague 脑膜炎是 感染的一种严重且常致命的表现形式。在使用生物武器进行攻击后，这种通常罕见的表现形式可能会在大量患者中出现，特别是如果治疗延迟发生的话。 plague 脑膜炎的危险因素、临床演变和最佳治疗策略尚未得到很好的理解。我们在 PubMed Central 和其他数据库中搜索了任何语言的 plague 脑膜炎报告。包含 plague 脑膜炎患者描述及其治疗和结局的文章被包括在内。在我们的搜索中，共确定了 1496 篇文章，其中 56 篇描述了 1898 年至 2015 年期间 84 例患者的文章符合纳入标准。患者的中位年龄为 16 岁（范围为 6 周至 64 岁）；68%为男性。大多数患者（n=50，60%）在原发性腺鼠疫后发生脑膜炎。常见的体征和症状包括发热（n=56，66%）、颈项强直（n=38，45%）和头痛（n=33，36%）；29%（n=24）的患者有颅神经异常等局灶性神经缺陷。几乎所有（n=23，96%）未接受抗生素治疗的患者死亡，而接受抗生素治疗的 59 例患者中，有 42%（n=25）死亡。根据接受的抗生素分组，患者的病死率为氟喹诺酮类 50%（2 例中的 1 例）、氨基糖苷类 19%（21 例中的 4 例）、磺胺类 14%（14 例中的 2 例）、氯霉素 11%（18 例中的 2 例）和四环素类 0%（13 例中无 1 例）。 plague 脑膜炎最常作为腺鼠疫的并发症发生，并可导致局灶性神经缺陷。接受抗生素治疗的患者更有可能存活；四环素类、氨基糖苷类和氯霉素的相关病死率最低。
