Pinhas-Hamiel O, Paret G, Barzilay Z
Pediatric Intensive Care Unit, Chaim Sheba Medical Center, Tel Hashomer.
Harefuah. 1993 May 2;124(9):546-8, 599.
3 children with the clinical picture of bacterial meningitis are described. Lumbar puncture was not done on admission due to increased intracranial pressure, cardiopulmonary shock, or petechial rash with suspected coagulopathy. Prompt treatment with broad spectrum antibiotics resulted in successful outcomes. The diagnosis of meningitis can usually be made clinically and the bacteriological diagnosis from blood cultures. We maintain that in fulminating cases lumbar puncture might prove fatal, and should therefore be deferred until the child's condition improves. However, if bacterial meningitis is suspected and lumbar puncture is delayed, intravenous antibiotics should be given immediately after blood is drawn for culture.
本文描述了3例具有细菌性脑膜炎临床表现的儿童。由于颅内压升高、心肺休克或伴有疑似凝血病的瘀点皮疹，入院时未进行腰椎穿刺。及时使用广谱抗生素治疗取得了成功的结果。脑膜炎的诊断通常可以通过临床症状以及血培养进行细菌学诊断。我们认为，在暴发性病例中，腰椎穿刺可能是致命的，因此应推迟到患儿病情改善后进行。然而，如果怀疑患有细菌性脑膜炎且腰椎穿刺延迟，在采集血样进行培养后应立即给予静脉抗生素治疗。
