Geiseler P J, Nelson K E, Levin S, Reddi K T, Moses V K
Rev Infect Dis. 1980 Sep-Oct;2(5):725-45. doi: 10.1093/clinids/2.5.725.
This review of 1,316 cases of purulent meningitis assessed changes in the etiology, clinical features, and fatality rate during the antibiotic era. Hemophilus influenzae was the most frequent cause of purulent meningitis (458 cases), Neisseria meningitidis the second most frequent (396 cases), and Streptococcus pneumoniae the third most frequent (178 cases). No bacterial etiology was found for 148 patients with purulent meningitis, the fourth major category of meningitis throughout the 23 years surveyed. Few patients had notable underlying diseases or predisposing conditions; 77.4% were less than 10 years old, but only 13 patients were less than one month old. Patients with meningitis caused by Staphylococcus aureus or various streptococci commonly had associated suppurative foci and the highest fatality rate. There were 103 deaths, of which 70.8% occurred during the first 48 hr of hospitalization. Antibiotics had been given to 54.6% of patients before admission to the hospital. Bacteriologic and cerebrospinal fluid (CSF) findings for patients who received antibiotics prior to admission ("pretreated") were compared with these findings for those who had not had antibiotics in 1,032 cases of meningitis caused by H. influenzae, N. meningitidis, or S. pneumoniae. No significant differences in white blood cell counts or in glucose or protein concentrations in CSF were noted among patients infected with any of the three organisms; positive cultures of blood and CSF were significantly less frequent in "pretreated" patients whose disease was caused by any of the three organisms, and particularly in those with meningitis due to N. meningitidis. Nasopharyngeal, throat, and rectal swabs and CSF specimens from 141 patients were cultured for virus. Enteroviruses were isolated from rectal swabs of two patients with bacterial meningitis and from the CSF of two patients (in mixed culture with Salmonella enteritidis in one case).
本项对1316例化脓性脑膜炎病例的综述评估了抗生素时代病因、临床特征及病死率的变化。流感嗜血杆菌是化脓性脑膜炎最常见的病因（458例），其次是脑膜炎奈瑟菌（396例），第三位是肺炎链球菌（178例）。148例化脓性脑膜炎患者未发现细菌病因，这是整个23年调查期间脑膜炎的第四大类。很少有患者有明显的基础疾病或易感因素；77.4%的患者年龄小于10岁，但只有13例患者年龄小于1个月。由金黄色葡萄球菌或各种链球菌引起脑膜炎的患者通常伴有化脓病灶且病死率最高。共有103例死亡，其中70.8%发生在住院的头48小时内。54.6%的患者在入院前已使用抗生素。在1032例由流感嗜血杆菌、脑膜炎奈瑟菌或肺炎链球菌引起的脑膜炎病例中，将入院前接受过抗生素治疗（“预处理”）的患者的细菌学和脑脊液（CSF）检查结果与未使用过抗生素的患者的这些结果进行了比较。感染这三种病原体中任何一种的患者，其脑脊液中的白细胞计数、葡萄糖或蛋白质浓度均未发现显著差异；在“预处理”患者中，由这三种病原体中任何一种引起疾病的患者，血液和脑脊液的阳性培养率明显较低，尤其是由脑膜炎奈瑟菌引起脑膜炎的患者。对141例患者的鼻咽、咽喉和直肠拭子以及脑脊液标本进行了病毒培养。从2例细菌性脑膜炎患者的直肠拭子以及2例患者的脑脊液中分离出肠道病毒（1例与肠炎沙门菌混合培养）。
