Almirante B, Cortés E, Pigrau C, Gasser I, del Valle O, Campos L, Pahissa A
Unidad de Enfermedades Infecciosas, Universitaria Vall d'Hebron, Barcelona.
Med Clin (Barc). 1995 Nov 25;105(18):681-6.
Pneumococcal meningitis (PM) is an infection with high morbidity and mortality. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of a recent series of adult patients with this disease.
Over a period of 10 years all the patients with PM diagnosed by isolation of this microorganism in the cerebrospinal fluid (CSF) were evaluated from a clinical, therapeutic and evolutive points of view. The impact of the new therapies in the disease and the variables associated with mortality were analyzed.
Seventy episodes of PM were diagnosed, 60% being found in patients over the age of 50 years. The male/female relationship was 2/1. Fifty-three percent of the patients had other underlying diseases. Acute otitis media (AOM) was the source in 34% of the cases, in 11% the patients had a fistula of CSF and in 9% a pneumonia. At the time of diagnosis 74% of the patients had some degree of reduction in the level of consciousness and in 40% of the episodes the presence of neurologic local manifestations were observed. A decrease in sensitivity to penicillin was observed in 33% of the microorganisms isolated. Third generation cephalosporins were used as initial treatment in 57 episodes and penicillin in other 11 episodes. Adjuvant treatment with dexamethasone, mannitol and/or diphenylhydantoin was administered in 54% of the patients. Overall mortality was 23%: the factors associated with an unfavourable evolution were the existence of underlying disease, deep alteration in the level of consciousness at the time of diagnosis, the coexistence of pneumonia and the absence of adjuvant therapy.
Mortality in pneumococcal meningitis is high. The most relevant risk factor is the initial degree of consciousness. Adjuvant therapies probably determine a reduction in the rate of mortality.
肺炎球菌性脑膜炎（PM）是一种发病率和死亡率都很高的感染性疾病。本研究的目的是评估近期一系列成年PM患者最相关的临床、流行病学和病情演变特征。
在10年期间，从临床、治疗和病情演变的角度对所有通过脑脊液（CSF）中分离出该微生物而确诊为PM的患者进行了评估。分析了新疗法对该疾病的影响以及与死亡率相关的变量。
共诊断出70例PM病例，60%发生在50岁以上的患者中。男女比例为2/1。53%的患者有其他基础疾病。34%的病例中急性中耳炎（AOM）是感染源，11%的患者有脑脊液瘘，9%的患者有肺炎。诊断时，74%的患者意识水平有一定程度下降，40%的病例观察到有神经局部表现。分离出的微生物中有33%对青霉素的敏感性降低。57例患者初始治疗使用第三代头孢菌素，11例使用青霉素。54%的患者接受了地塞米松、甘露醇和/或苯妥英钠的辅助治疗。总体死亡率为23%：与病情预后不良相关的因素包括存在基础疾病、诊断时意识水平深度改变、合并肺炎以及未接受辅助治疗。
肺炎球菌性脑膜炎的死亡率很高。最相关的危险因素是初始意识程度。辅助治疗可能会降低死亡率。
