Department of Neurology, The Fourth Affiliated Hospital of Guangxi Medical University/Liuzhou Workers' Hospital, Liuzhou, China.
Am J Trop Med Hyg. 2023 Jan 23;108(3):477-481. doi: 10.4269/ajtmh.22-0515. Print 2023 Mar 1.
We analyzed the clinical characteristics and outcomes of patients with Streptococcus suis meningitis in Liuzhou, China, to improve diagnostic accuracy and lower the chances of misdiagnosis. The major clinical manifestations, auxiliary examination results, treatment strategies, treatment efficacy, and follow-up results of 17 consecutively admitted patients with S. suis meningitis were evaluated. The most common clinical manifestations were fever (15/17), sensorineural hearing loss (13/17), headache (11/17), and altered mental status (8/17). In addition, 64.71% of the patients had residual symptoms of sensorineural hearing loss at discharge, and moderate disabilities occurred in 68.75% of the patients in the form of sensorineural deafness (11/17) and hemiparesis (1/17). The cerebrospinal fluid (CSF) of nine patients was used for metagenomic analysis with next-generation sequencing. The metagenomic analysis of CSF of four patients was positive, whereas blood and CSF cultures were negative. The average modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scores improved significantly at the 6-month follow-up compared with those at admission (P < 0.05). There was no correlation between altered mRS and ADL scores and the CSF findings (P > 0.05). Early administration of antibiotics can prevent sensorineural hearing loss. Early CSF metagenomic analysis may be superior to blood and CSF culture.
我们分析了中国柳州链球菌性脑膜炎患者的临床特征和结局,以提高诊断准确性并降低误诊的可能性。评估了 17 例连续入院的链球菌性脑膜炎患者的主要临床表现、辅助检查结果、治疗策略、治疗效果和随访结果。最常见的临床表现是发热(15/17)、感觉神经性听力损失(13/17)、头痛(11/17)和精神状态改变(8/17)。此外,64.71%的患者出院时仍有感觉神经性听力损失残留症状,68.75%的患者以感觉神经性耳聋(11/17)和偏瘫(1/17)的形式出现中度残疾。对 9 名患者的脑脊液(CSF)进行了下一代测序的宏基因组分析。4 名患者的 CSF 宏基因组分析呈阳性,而血液和 CSF 培养均为阴性。与入院时相比,6 个月随访时平均改良 Rankin 量表(mRS)和日常生活活动(ADL)评分显著改善(P<0.05)。mRS 和 ADL 评分的改变与 CSF 发现之间无相关性(P>0.05)。早期使用抗生素可以预防感觉神经性听力损失。早期 CSF 宏基因组分析可能优于血液和 CSF 培养。