结核性和病毒性脑膜炎鉴别诊断的回顾性研究

目的 研究结核性和病毒性脑膜炎多项实验室指标在鉴别诊断中的量化标准和敏感性，探讨患者入院后脑脊液蛋白含量显著增高的影响因素。方法 对29例结核性和31例病毒性脑膜炎患者进行回顾性对比研究，比较其临床症状、外周血和脑脊液的实验室检测结果，采用Logistic回归分析脑脊液蛋白含量显著增高的影响因素。结果 结核性脑膜炎从临床症状、血常规、血糖、脑脊液白细胞及分类上很难与病毒性脑膜炎相鉴别。与病毒性脑膜炎相比，当脑脊液的糖含量＜2.5mmol/L、脑脊液蛋白含量＞1.0g/L、脑脊液氯化物含量＜120.0mmol/L、脑脊液糖与血糖比值＜0.50时应高度疑诊为结核性脑膜炎。上述指标鉴别结核性脑膜炎的敏感性为：脑脊液糖与血糖比值＜0.50，高于脑脊液的糖含量＜2.5mmol/L；脑脊液蛋白含量＞1.0g/L，高于脑脊液氯化物含量＜120.0mmol/L。脑脊液蛋白含量＞1.0g／L与脑脊液氯化物含量＜122．8mmol/L呈负相关。结论 上述指标的量化标准有助于提高结核性与病毒性脑膜炎鉴别诊断的敏感性和准确性。     

降钙素原在不同病原体感染脑膜炎中的临床价值

目的分析降钙素原(procalcitonin,PCT)在不同病原体感染脑膜炎中的临床价值。方法 103例急性脑膜炎患者在抗生素治疗前行腰穿检查,根据临床表现和脑脊液细胞学检查结果分成细菌性脑膜炎组和病毒性脑炎组。PCT、外周血CRP和血常规白细胞计数在入院和治疗后分别测定,采用化学发光免疫分析法检测103例急性脑膜炎患儿血清PCT及脑脊液PCT。结果治疗前细菌性脑膜炎组患者血清PCT浓度(15.36±7.25)ng/mL,脑脊液PCT浓度(0.91±0.32)ng/mL,病毒性脑膜炎组患者血清PCT浓度(0.88±0.42)ng/mL,脑脊液PCT浓度(0.23±0.11)ng/mL,2组比较差异均有统计学意义(P0.05)。经抗生素治疗后细菌性脑膜炎组患儿血清PCT浓度(6.78±3.45)ng/mL,明显低于治疗前,差异有统计学意义(P0.05)。结论降钙素原对鉴别细菌性脑膜炎和病毒性脑膜炎具有重要的临床价值,同时也可作为细菌性脑膜炎的疗效指标。     

结核性脑膜炎与新型隐球菌性脑膜炎病例鉴别分析

目的分析结核性脑膜炎和新型隐球菌脑膜炎病例的临床表现、颅内压、脑脊液常规和生化改变,为鉴别诊断这两种脑膜炎提供参考依据。方法收集2009-01—2011-12第1次我院38例结核性脑膜炎和18例新型隐球菌患者的基本资料、临床表现、颅内压、脑脊液常规和生化检测数据,采用日立7180型全自动生化分析仪测定脑脊液中白细胞数、糖、氯化物和蛋白含量。结果不论结核性脑膜炎还是新型隐球菌脑膜炎均以亚急性起病、颅压升高、脑脊液白细胞数和蛋白含量升高、糖含量和氯化物含量降低为主。但结核性脑膜炎病例脑脊液中白细胞数和蛋白含量高于新型隐球菌脑膜炎患者(P<0.05),而前者的氯化物含量却低于后者(P<0.05),在颅压变化程度和糖含量方面两种疾病间无显著性差异(P>0.05)。结论结核性脑膜炎与新型隐球菌脑膜炎的临床表现、颅内压、脑脊液常规和生化检测结果有一定诊断价值,但仍应进一步寻找病原菌明确诊断。     

新型隐球菌性和结核性脑膜炎的临床鉴别

目的 :探讨新型隐球菌性和结核性脑膜炎的临床和脑脊液及神经影像学鉴别要点。方法 :回顾性对比分析两种脑膜炎的主要临床表现 ,脑脊液及脑 CT或 MRI改变。结果 :新型隐球菌性脑膜炎亚急性起病 ,进展性头痛 ,轻—中度发热 ,视乳头水肿伴有出血 ,脑脊液压力高 ,蛋白升高多在 0 .5～ 1g/ L之间 ,而葡萄糖含量明显下降 ;结核性脑膜炎多以急性起病 (71.43% ) ,夜间头痛为主 ,发热在 38.5℃以上 ,脑脊液蛋白明显升高伴氯化物的降低。两种脑膜炎脑脊液白细胞数差异无显著性 ;神经影像学改变各有不同。结论 :根据起病形式 ,临床特征 ,结合脑脊液及神经影像学检查可以初步对两种脑膜炎进行鉴别 ,确诊有待于病原学检查     

小儿急性细菌性脑膜炎患者趋化因子CXCL-5和IL-8的表达

细菌性脑膜炎主要病理生理特征是外周血和脑脊液（CSF）中有大量的中性粒细胞浸润或聚集，这些感染后的机体反应对清除细菌感染起着重要的作用，然而免疫反应也诱导了局部（脑脊膜）的炎症损伤。CXCL-5和IL-8是诱导中性粒细胞激活和移动的重要趋化因子。作者通过检测小儿急性细菌性脑膜炎患者外周血和脑脊液中CXCL-5和IL-8水平变化，旨在探讨它们在疾病发生过程中的作用。     

小儿急性细菌性脑膜炎患者C反应蛋白水平及临床意义

目的 检测小儿急性细菌性脑膜炎患者外周血和脑脊液中C反应蛋白(CRP)水平,并探讨其在疾病发展过程中的价值.方法 采集28例急性细菌性脑膜炎患儿和18例健康儿童外周血和脑脊液标本,检测CRP浓度,评价临床价值.结果 急性细菌性脑膜炎患儿外周血和脑脊液中CRP水平明显比对照组高(P < 0.05).经使用抗生素治疗后,急性细菌性脑膜炎患儿外周血和脑脊液中CRP水平显著下降(P < 0.05).结论 急性细菌性脑膜炎患儿外周血和脑脊液中CRP明显升高,可用于判断疾病发展的转归.     

脑脊液与血浆的蛋白、糖、氯化物不同比值鉴别诊断结核性脑膜炎与病毒性脑膜炎的意义

目的 研究脑脊液(CSF)与血浆的蛋白、糖、氯化物含量不同比值鉴别诊断结核性脑膜炎(结脑)与病毒性脑膜炎(病脑)的意义.方法 检测102例结脑和107例病脑患者CSF和血浆的蛋白、糖、氯化物含量,计算CSF与血浆的蛋白、糖、氯化物含量3种不同比值(CSF/血浆蛋白≥0.2、糖≤0.5、氯≤0.7,CSF/血浆蛋白≥0.1、糖≤0.6、氯≤1.1,CSF/血浆蛋白≥0.3、糖≤0.4、氯≤0.6)诊断结脑的敏感性和特异性.结果 结脑组CSF与血浆的蛋白、糖、氯化物含量3种比值的阳性率均显著高于病脑组(P<0.05～0.01);以CSF/血浆的蛋白≥0.2、糖≤0.5、氯≤0.7诊断结脑的敏感性(96.1%,97.1%,99.0%)和特异性(97.2%,98.1%,99.1%)均较高,而CSF/血浆的蛋白>10.1、糖≤0.6、氯≤1.1的特异性(66.4%,69.2%,75.7%)较低,CSF/血浆的蛋白≥0.3、糖≤0.4、氯≤0.6的敏感性(48.0%,44.1%,42.2%)较低.结论 CSF与血浆的蛋白、糖、氯化物含量比值≥0.2、≤0.5及≤0.7对鉴别诊断结脑与病脑具有重要意义.     

37例培养阳性结核性脑膜脑炎脑脊液细胞学动态分析

目的探讨脑脊液结核分枝杆菌培养阳性结核性脑膜炎脑脊液细胞学特点。方法运用玻片细胞沉淀(粟秀初教授研制)细胞学方法,对37例使用Bactec MGIT 960培养阳性结核性脑膜炎患者的脑脊液细胞学分类特点进行动态观察与分析。结果结核性脑膜脑炎患者脑脊液白细胞总数升高,但有4例患者脑脊液白细胞数小于50×106/L。多数确诊结核性脑膜炎患者脑脊液呈混合型细胞反应,有33例(89.2%)患者脑脊液中检测到中性粒细胞,25例(67.6%)患者脑脊液中检测到浆细胞。但多数患者脑脊液(60%)以淋巴细胞为主,少量(1/3)以中性粒细胞为主。且几乎所有患者脑脊液内均可以检测到浆细胞的存在。结论确诊结核性脑膜炎患者的脑脊液白细胞数明显增高,脑脊液细胞分类主要表现为淋巴细胞为主型,少部分为中性粒细胞为主型。     

急性细菌性脑膜炎患儿外周血上皮嗜中性粒细胞激活肽水平及其意义

急性化脓性脑膜炎是婴幼儿较常见的一种中枢神经系统感染，严重影响着小儿健康，具有极高的病死率，抢救不及时多留有中枢神经系统并发症，给患者和社会带来负担。自抗生素应用以来其病死率已由50％～90％降至10％以下。但若不及时治疗，幸存者会遗留有严重的神经系统后遗症，给社会和家庭造成沉重负担。细菌性脑膜炎主要病理生理特征是外周血和脑脊液中有大量的中性粒细胞浸润或聚集，这些感染后的机体反应对清除细菌感染起着重要的作用，然而免疫反应也诱导脑脊膜的炎症损伤。上皮嗜中性粒细胞激活肽（CXCL-5）是诱导中性粒细胞激活和移动的重要趋化因子。作者通过检测小儿急性细菌性脑膜炎患者外周血中CXCL-5水平变化，旨在探讨其在疾病发生过程中的作用。     

结核性与化脓性脑膜炎的脑脊液生化指标鉴别诊断

目的研究脑脊液生化指标在结核性脑膜炎和化脓性脑膜炎鉴别诊断中的应用价值。方法选择我院收治的102例结核性脑膜炎患者(结脑组)及89例化脓性脑膜炎患者(化脑组)为研究对象。对全部患者血浆及脑脊液中的蛋白、糖、氯化物和腺苷脱氨酶(ADA)进行检测。同时,对脑脊液与血浆中的蛋白、糖、氯化物和ADA比值进行计算并比较。结果结脑组脑脊液检测中,氯化物水平显著低于化脑组(P0.01),ADA水平显著高于化脑组(P0.01);结脑组血浆检测中,蛋白及氯化物水平显著低于化脑组(P0.01),ADA水平显著高于化脑组(P0.01);结脑组脑脊液与血浆生化指标比值中,蛋白及ADA的比值显著高于化脑组(P0.05),氯化物的比值显著低于化脑组(P0.01)。结论脑脊液中氯化物和ADA水平及脑脊液和血浆中蛋白、ADA及氯化物的比值对结核性脑膜炎和化脓性脑膜炎的早期鉴别诊断具有一定的价值。     

Streptococcus salivarius meningitis: a case report and literature review

Twelve hours after spinal anaesthesia, a 61-year-old patient developed meningitis with fever, somnolence, headache and stiffness of the neck. The cerebrospinal fluid was found to contain 5.279/mm³ cells (95 granulocytes), 12.800 mg/l protein and 14.0 mmol/l lactate. Streptococcus salivarius was detected in the culture. The patient was treated with antibiotics (initially cefotaxime, fosfomycin and gentamycin, later piperacillin and sulbactam). Restitutio ad integrum took place after 7 days. Thirteen cases of Streptococcus salivarius meningitis over the past 40 years are described in the literature, nine of which occurred following spinal puncture. Streptococcus salivarius was probably communicated by the medical personnel from the oral cavity when working without masks. The outcome in each case was good. In our opinion suitable masks must be worn during spinal puncture. Although iatrogenic infection is uncommon, it cannot be ruled out.     

Anaerobic meningitis in an infant associated with pilonidal cyst abscess

A 5-month-old infant whose infected pilonidal sinus was surgically removed, developed meningitis due to Bacteroides fragilis. A similar organism was also recovered from the infected pilonidal cyst along with anaerobic Gram positive cocci. The patient was treated with intravenous chloramphenicol for 4 weeks and recovered without sequela. Attention should be paid to the possibility of meningitis due to anaerobes in children with an infected pilonidal sinus.     

Purulent meningitis in the newborn

Neonatal meningitis is characterized by unusual clinical manifestations caused by unusual organisms (with a marked predominance of gram-negative organisms), a poor prognosis due to the failure of antibiotics to penetrate the blood-brain barrier, and frequent complications (ventriculitis, hydrocephalus, and brain damage). The literature is reviewed and our personal experience described. The clinical and bacteriological findings, the complications and results of various therapeutic regimes, and the factors affecting prognosis are discussed.     

Meningitis due to viridans streptococci in adults

Seven patients are reported with meningitis due to viridans streptococci. These patients represented 5% of culture-proven cases of bacterial meningitis in adults participating in a prospective multicentre clinical trial evaluating the use of dexamethasone. Meningitis was iatrogenic in three patients: one patient had been treated with endoscopic sclerotherapy for oesophageal varices, and two patients had undergone thermocoagulation of the gasserian ganglion for trigeminal neuralgia in the previous days. Received: 8 January 1997 Received in revised form: 17 March 1997 Accepted: 3 April 1997     

A retrospective clinical, laboratory and outcome analysis in 43 cases of acute aseptic meningitis

Forty-three consecutive cases of acute aseptic meningitis (AAM) presenting within a 24-months period were retrospectively analysed with respect to clinical symptomatology, cerebrospinal fluid (CSF) findings, clinical course, treatment and outcome. Nineteen of the 43 AAM cases (44%) were caused by enterovirus, one by HIV (2%), two by Varicella zoster virus (5%), three due to herpes simplex virus I (7%), two due to herpes simplex virus II (5%), one due to Central European encephalitis virus (2%), and in 15 patients (35%) the aetiology of AAM remained unknown. Headache (100%) and fever (93%) were the presenting symptoms in the majority of cases. Signs of preceding infection were predominantly gastrointestinal in the enterovirus subgroup, but were inconsistently observed in the other subgroups. CSF findings at the first lumbar tap on admission generally revealed lymphomonocytic pleocytosis of less than 500 cells per micro l, mild to moderately elevated protein and normal lactate and glucose levels. Initial therapy consisted of an empirical antiviral and antibiotic regimen until a serological diagnosis was available. Acyclovir, effective only in herpes family viruses, was initially administered to all AAM cases. Effective therapy for other viral pathogens are not broadly available and treating AAM of unknown aetiology imposes a particular problem. The average hospitalization time ranged from 16 to 31 days. Patients were either discharged home (72%) or transferred to a rehabilitation centre (28%). The outcome was good (40%) to fair (51%) in the majority of cases.     

新型隐球菌性脑膜炎与结核性脑膜炎的鉴别

目的探讨新型隐球菌性脑膜炎(CNM)和结核性脑膜炎(TBM)在临床、脑脊液方面的区别,以期早期诊断、治疗,改善病人的预后。方法回顾性比较10例CNM和86例TBM患者的临床特点、脑脊液改变的异同。结果两种脑膜炎均以亚急性或慢性形式起病,CNM组患者视盘水肿和呕吐症状明显多于TBM组;CNM组患者脑脊液开放压力和细胞数增加更明显,但头痛、发热、抽搐、精神症状、消瘦、盗汗、大小便障碍、意识障碍、脑膜刺激征、病理征阳性、脑神经损伤、肢体瘫痪、感觉障碍以及脑脊液蛋白质、葡萄糖、氯化物改变等均无显著差异。结论综合分析临床资料和脑脊液资料有助于鉴别两种脑膜炎。     

Discrepancies between brain CT imaging and severely raised intracranial pressure proven by ventriculostomy in adults with pneumococcal meningitis

Objectives: Computed tomography (CT) of the brain is recommended for assessment of intracranial pressure (ICP) of patients with acute bacterial meningitis who are comatose or show focal neurological deficits. The aim of this report is to draw attention to the possibility of a discrepancy between CT findings and ICP values in some patients with pneumococcal meningitis. Methods: We describe three adult patients with pneumococcal meningitis who had both successive CT examinations and ICP measurements at the time of clinically evident cerebral herniation (n = 2) and/or prolonged coma (n = 2). Results: Although measurements with a ventriculostomy catheter indicated that all three patients had severely raised ICP values of 90, 44, and 45 mmHg, repeated cranial CT greatly underestimated true ICP values. Despite clinical evidence of acute cerebral herniation, it was not detected in the contemporary CT findings of two patients. Continuous ICP monitoring in the ICU helped to guide treatment for increased ICP; nevertheless, two patients died. Conclusions: The clinician must be aware that cranial CT may fail to rule out the possibility of severely raised ICP or cerebral herniation in a patient with pneumococcal meningitis. Therefore, ICP monitoring of patients with bacterial (especially pneumococcal) meningitis who are in prolonged coma should be considered early and regardless of the cranial CT appearances. Received: 7 November 2001, Received in revised form: 8 April 2002, Accepted: 16 April 2002     

Comparative analysis of cerebrospinal fluid adenosine deaminase in tuberculous and non-tuberculous meningitis

Objective

To calculate cut-off point for the adenosine deaminase (ADA) activity in the CSF of patients with tuberculous meningitis (TBM).

Patients and methods

The ADA assay was based on the automatic indirect method in which ADA catalyzes adenosine to inosine. ADA activity in the CSF was calculated based on ammonia liberated from adenosine and quantified spectrophotometrically. Arithmetic mean values and standard deviation of each variable were measured. Mann–Whitney U and Fisher exact tests were applied to compare continuous and dichotomous variables between tuberculous and non-tuberculous groups. A receiver operating characteristic curve was plotted to identify various cut-off points to determine the best level for ADA activity.

Results

Totally 42 patients were enrolled into the study. The median of ADA activity in the TBM group was 22 and in the non-TBM group was 8.0. The mean CSF-ADA activity was found to be significantly higher in TBM group (23.05 ± 13.1 IU/L) than in the CSF from non-TBM patients (9.39 ± 5.18 IU/L). The highest accuracy is at the cut-off value of 10.5 IU/L. The sensitivity and specificity of the test at this cut-off to differentiate TBM from non-tuberculous meningitis is 81% and 86% respectively.

Conclusion

Considering that a high positive value of ADA activity cannot confirm TBM, however, in suspected patients it may lead the physician to treat patient earlier before the confirmatory diagnostic reports will be received. The suggested cut-off value in this pilot study is 10.5 IU/L with high sensitivity and specificity.     

新型隐球菌性脑膜炎与结核性脑膜炎的临床特点比较

目的对比和分析综合性医院新型隐球菌性脑膜炎(CNM)与结核性脑膜炎(TBM)的临床特点。方法分析62例CNM及219例TBM患者的一般资料、临床症状、脑脊液细胞学(CSFC)、头颅影像学的特点。结果两种脑膜炎均呈亚急性或慢性起病相对于TBM,CNM延误诊断时间更长、临床症状中癫痫出现比率(24.2%)、头颅影像学中脑膜强化出现比率(17.7%)较高,腰穿脑脊液(CSF)压力(268.7±67.6mmH_2O)、CSF单核细胞占比(21.0±17.5%)高,CSF白细胞计数(84.8±88.1×10~6/L)、CSF糖(1.9±1.4mmol·L~(-1))较低。结论两种脑膜炎临床表现不典型,两者之间不易鉴别,容易误诊漏诊。临床上需综合判断,CSF瑞氏吉姆萨染色和改良抗酸染色有助于两者病原学确诊。