Incidence and characteristics of childhood suppurative meningitis in Hungary in 1983-87

Data of 1208 infants and children hospitalized for purulent meningitis were analysed. The incidence of the disease was closely age related: morbidity calculated for 100,000 children was found 97.5 under one year of age; 15.6 in 1 to 5 and 2.2 in 6 to 14 years of age. Incidence of newborn meningitis cases was 3.7 per 10,000 live-borns. The disease was caused by N. meningitidis in 278 (23%), H. influenzae in 171 (14%), S. pneumoniae in 157 (13%), E. coli in 74 (6%), B-group streptococcus in 61 (5%), other bacteria (altogether 17 species) in 107 (9%) cases, while in 360 cases (30%) the etiology remained unknown. Overall case fatality was 19.6 per cent. When compared to international data mortality was especially high among the newborns (53%) and in meningitis cases due to S. pneumoniae (29%), E. coli (48%), B-group streptococcus (37%) and "other bacteria" (41%). Neurologic sequelae were found in 17 per cent of the patients at discharge however, in newborns it was 54 per cent. Since the antibacterial therapy was appropriate in all cases, authors try to reveal the possible causes of the relatively high mortality and make recommendations for reducing it.     

Incidence of meningitis and of death from all causes among users of cochlear implants in the United Kingdom

BACKGROUND: During 2002, there was an increase in reports of bacterial meningitis among people with cochlear implants in Europe and North America. One model of implant, which included a space-occupying 'positioner', was recalled. Implantation of a positioner was shown to be a risk factor for meningitis among children in the United States. The situation in the United Kingdom was not known. METHODS: We ascertained the cohort of people who had received cochlear implants with intra-cochlear electrodes in UK hospitals prior to 1 October 2002 and were permanently resident in the United Kingdom. We compared the incidence of meningitis, and the causes and incidence of death from all causes, between the cohort and reference populations. RESULTS: Of 1851 children (66 with positioners), none had contracted meningitis. Neither the incidence rate of meningitis, nor the cumulative mortality from all causes, differed significantly between implanted children and values expected for the general population. Of 1779 adults (139 with positioners), five had contracted meningitis with three fatalities. No case of meningitis involved a positioner and four of the cases, including the fatalities, possessed risk factors unrelated to implantation. Although the incidence rate of meningitis was significantly higher in implanted adults than the general population, cumulative mortality from all causes was never higher, and was significantly lower at some time points after implantation. CONCLUSION: Specific evidence of the association between bacterial meningitis and implantation with a positioner that arose in the United States and mainland Europe during 2002 has not been found in the United Kingdom.     

Incidence of bacterial meningitis in Asia using enhanced CSF testing: polymerase chain reaction, latex agglutination and culture

To enhance the detection of bacterial meningitis in an East Asian surveillance study, we employed cerebrospinal fluid (CSF) bacterial culture, latex agglutination (LA) and polymerase chain reaction-enzyme immunoassay (PCR-EIA) testing for Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Sp). The sensitivity and specificity of CSF PCR-EIA testing was compared to LA and culture. A meningitis case was defined by one positive result for any of the three tests. The sensitivity of H. influenzae CSF PCR-EIA, LA, and culture was 100%, 40% and 57.5% respectively; and for Sp CSF PCR-EIA, LA and culture, the sensitivity was 100%, 58.3% and 66.7%, respectively. Hib and Sp specificity was 100% by each method. CSF PCR-EIA was more sensitive than culture or LA for the detection of Hib and Sp meningitis cases increasing their incidence by 74% and 50% compared to culture respectively. CSF PCR-EIA should be included for the detection of bacterial meningitis in surveillance studies.     

Modelling meningococcal meningitis in the African meningitis belt

SUMMARYMeningococcal meningitis is a major public health problem in a large area of sub-Saharan Africa known as the meningitis belt. Disease incidence increases every dry season, before dying out with the first rains of the year. Large epidemics, which can kill tens of thousands of people, occur frequently but unpredictably every 6-14 years. It has been suggested that these patterns may be attributable to complex interactions between the bacteria, human hosts and the environment. We used deterministic compartmental models to investigate how well simple model structures with seasonal forcing were able to qualitatively capture these patterns of disease. We showed that the complex and irregular timing of epidemics could be caused by the interaction of temporary immunity conferred by carriage of the bacteria together with seasonal changes in the transmissibility of infection. This suggests that population immunity is an important factor to include in models attempting to predict meningitis epidemics.     

结核性脑膜炎与其他脑膜炎的鉴别诊断

目的 了解结核性脑膜炎(结脑)的临床特征及其与病毒性脑膜炎(病脑)、隐球菌性脑膜炎(隐脑)和化脓性脑膜炎(化脑)鉴别诊断要点,提高治愈率.方法 收集2013年1月至2015年12月间在浙江省人民医院住院的结脑患者45例,病脑患者20例、隐脑患者15例和化脑患者15例的临床资料,并比较其临床特征.结果 结脑患者常合并肺结核或肺外结核疾病(29例,64.4％);基础疾病以艾滋病、糖尿病和高血压多见;起病形式多样,但以亚急性和慢性起病为主(分别为26例,57.8％和11例,24.4％);结脑早期临床表现主要以发热(45例,100％)、头痛(29例,64.4％)和恶心呕吐(27例,60.0％)为主,进而可出现颅神经和脑实质损害征象;脑脊液符合特征性的改变,并见腺苷脱氨酶含量升高达(6.67±5.32) U/L.影像学上表现以脑实质改变多见(16例,35.6％).结论 结脑的早期诊断需综合临床表现、脑脊液检查、影像学检查,其中脑脊液检查和及时的头颅CT或磁共振检查对诊断尤为重要.     

Prophylaxis in bacterial meningitis

A questionnaire about the use of prophylactic antibiotics in bacterial meningitis was sent to medical officers of environmental health and microbiologists in England. There was broad agreement that prophylaxis should be offered to close contacts of acute meningitis due to Neisseria meningitidis but not to contacts of meningitis caused by Streptococcus pneumoniae. Overall 28% of those who replied said they could consider giving prophylaxis to contacts of meningitis due to Haemophilus influenzae. Rifampicin was the most common choice of drug. The indications for prophylaxis in bacterial meningitis are discussed.     

新生儿重症化脓性脑膜炎与普通化脓性脑膜炎的对比分析

目的 探讨新生儿重症化脓性脑膜炎和普通化脓性脑膜炎的病原菌分布、临床特点及转归的不同,为临床早期鉴别重症化脓性脑膜炎,及时治疗和判断预后提供依据。 方法 选取2019年10月—2022年10月收治的135例新生儿化脓性脑膜炎病例,按病情严重程度分为重症组和普通组,回顾性收集临床资料,分析两组新生儿的临床症状体征、辅助检查及转归的差异。 结果 135例新生儿化脓性脑膜炎中,重症组60例,普通组75例。与普通组相比,重症组早产儿、低出生体重儿、出生窒息史所占比例以及胎膜早破发生率均增高(均P＜0.05),反应差、惊厥、神志异常、呼吸增快、心率增快、低氧血症、血小板计数降低、肝功能损伤、肾功能损伤的发生率明显升高(均P＜0.05)。重症组脑脊液白细胞计数、蛋白质浓度高于普通组,脑脊液糖浓度低于普通组,并发症的发生率高于普通组(均P＜0.05)。反应差、肝功能损伤、低氧血症、脑脊液蛋白质浓度升高及脑脊液糖浓度降低是新生儿重症化脓性脑膜炎的独立危险因素。 结论 新生儿重症化脓性脑膜炎和普通化脓性脑膜炎在临床表现、实验室检查及并发症方面存在一定的差异,早期可以通过临床表现和实验室检查来鉴别新生儿重症化脓性脑膜炎,做到早期识别、积极治疗。     

病毒性脑膜炎

1　引言病毒性脑膜炎是由各种病毒感染软脑膜 (软膜和蛛网膜 )后引起弥漫性炎症的一组临床综合征。临床主要表现发热、头痛和脑膜刺激征。病毒性脑膜炎是临床最常见的无菌性脑膜炎 ,后者则常指脑脊液中未找到常见病原菌的一组脑膜炎综合征。随着组织培养技术的发展和多聚酶链反应技术的应用 ,使病毒性脑膜炎的诊断阳性率明显提高。2　病因和发病机制85 %～ 95 %的无菌性脑膜炎由肠道病毒引起。该病毒属于微小核糖核酸病毒科 ,有 6 0多个不同的亚型 ,包括脊髓灰质炎病毒、柯萨奇病毒Ａ和Ｂ、埃可病毒等 ;虫媒病毒和单纯疱疹病毒 (ＨＳＶ )也…     

Tuberculous meningitis

Tuberculous meningitis is a grave, yet curable, illness. It is a rare condition nowadays and may present special problems when the clinical picture is untypical. Clinical awareness, early diagnosis and vigorous treatment are the key to therapeutic success.     

2004 — 2005年我国流行性脑脊髓膜炎病死率分析

接种疫苗是预防流行性脑脊髓膜炎（流脑）最有效、最经济的方法,在过去几十年,随着疫苗的广泛使用,流脑发病率显著下降。目前在中国上市的疫苗主要包括A、C、W、Y群单价和多价多糖脑膜炎球菌疫苗（MPV）,A、C群多糖脑膜炎球菌结合疫苗（MPCV-AC）以及A、C群脑膜炎球菌多糖结合b型流感嗜血杆菌结合联合疫苗（MPCV-AC-hib）。纵观我国脑膜炎球菌疫苗近50年的发展历程,在疫苗生产、质量控制以及相关研究方面均取得了显著成绩,但仍然面临着流脑疾病负担被低估、脑膜炎球菌疫苗免疫策略尚未完善、不同厂家脑膜炎球菌疫苗免疫程序不统一、无B群脑膜炎球菌疫苗上市等问题和挑战,为此应不断提高流脑监测手段及系统开展流脑疾病负担评价的研究以助力我国脑膜炎球菌疫苗免疫策略和免疫程序的完善,并针对流脑血清群高度可变和易发生抗原漂移的特性通过基因重组等技术研发出免疫力更长、保护效果更好的可预防所有血清群流脑的通用性疫苗。     

螺旋体脑膜炎

螺旋体脑膜炎主要由一组不同菌群经人类、哺乳动物、鸟类及昆虫作为媒介在全世界范围内传染的中枢神经系统 (ＣＮＳ)感染疾病 ,因其传染方式独特隐蔽、潜伏期长、症状多样化及需特异性相关抗原、抗体检查 ,或需从血、ＣＳＦ中寻找病原体及培养才能确诊 ,故易被临床疏忽 ;今就常见的螺旋体脑膜炎有关问题叙述如下。1　梅毒性脑膜炎梅毒是由苍白螺旋体 (ｔｒｅｐｏｎｅｍｉａｐａｌｌｉｄｕｍ )感染引起的一种全身性疾病 ,感染人体后经 1～ 3个月即可侵入ＣＮＳ ,如未经规则驱梅毒治疗 ,约有 5 %～10 %的患者在以后的 5～ 10年中出现神经系统…