Balkundi D R, Murray D L, Patterson M J, Gera R, Scott-Emuakpor A, Kulkarni R
Department of Pediatrics, Michigan State University, East Lansing 48824-1316, U.S.A.
J Pediatr Hematol Oncol. 1997 Jan-Feb;19(1):82-5. doi: 10.1097/00043426-199701000-00013.
The purpose of this report is to emphasize the importance of occurrence of Streptococcus mitis meningitis in febrile neutropenic children with hematopoietic malignancy.
Symptoms of meningitis and sepsis (fever, headache, changes in mental status) were seen in three patients who were severely neutropenic and undergoing cytotoxic chemotherapy for CNS relapse of their underlying malignancy (acute lymphoblastic leukemia (ALL), n = 2; Burkitt's lymphoma, n = 1). Chemotherapy had included cytosine arabinoside administered 7-14 days prior to presenting with sepsis and meningitis. All three patients had buccal mucositis or sinusitis. Blood cultures and CSF cultures showed S. mitis resistant to penicillin but sensitive to vancomycin. Vancomycin, at a dosage of 60 mg/kg/day to maximize CNS levels of antibiotic, was administered to all three children.
Two of the patients recovered from S. mitis meningitis; recovery was associated with an improvement in their peripheral granulocyte counts. One patient, who remained neutropenic, died despite being treated with both intravenous and intraventricular vancomycin.
Physicians caring for patients who are neutropenic and febrile need to be aware of the risk of meningitis occurring with S. mitis sepsis. Early treatment with high dosages of vancomycin (60 mg/kg/day) and an attempt to limit the duration of neutropenia are important factors in the outcome of such patients.
本报告旨在强调在患有血液系统恶性肿瘤的发热性中性粒细胞减少儿童中发生缓症链球菌脑膜炎的重要性。
三名严重中性粒细胞减少且因潜在恶性肿瘤（急性淋巴细胞白血病（ALL），n = 2；伯基特淋巴瘤，n = 1）的中枢神经系统复发而接受细胞毒性化疗的患者出现了脑膜炎和败血症症状（发热、头痛、精神状态改变）。化疗包括在出现败血症和脑膜炎前7 - 14天给予阿糖胞苷。所有三名患者均有颊部粘膜炎或鼻窦炎。血培养和脑脊液培养显示缓症链球菌对青霉素耐药但对万古霉素敏感。对所有三名儿童均给予剂量为60 mg/kg/天的万古霉素，以最大化抗生素在中枢神经系统的浓度。
两名患者从缓症链球菌脑膜炎中康复；康复与外周粒细胞计数的改善相关。一名仍为中性粒细胞减少的患者尽管接受了静脉和脑室内万古霉素治疗仍死亡。
照顾中性粒细胞减少和发热患者的医生需要意识到缓症链球菌败血症并发脑膜炎的风险。早期给予高剂量万古霉素（60 mg/kg/天）治疗以及尝试缩短中性粒细胞减少的持续时间是此类患者预后的重要因素。
