不同病期小儿结核性脑膜炎神经影象学改变与临床的关系

为了解不同病期结核性脑膜炎（TM）患儿的头颅CT、MRI改变及与临床的关系,对91例不同病期TM患儿的头颅CT、MRI及临床进行分析。结果头颅CT检查67例,异常58例,异常率为86．6％;头颅MRI检查38例,异常35例,异常率为92．1％。CT改变特点与MRI基本一致,早期公为脑池改变或轻度脑实质低密度影;中期则发展为脑水肿、脑积水;晚期可见脑实质低密度、混杂高密度影及脑池受压、闭塞、粘连等。临床疗效良好者影像学改变轻,疗效差者影像学改变重。提示CT、MRI检查,尤其MRI对TM的诊断、病期和预后判定有重要意义。     

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目的 探讨儿童结核性脑膜炎临床特征与卡介苗(BCG)接种之间的关系.方法 将重庆医科大学附属儿童医院2004-2007年122例儿童结核性脑膜炎按是否接种BCG分为BCG组(54例)和未接种BCG组(68例),对临床资料进行回顾性分析.结果 0～5岁为发病高峰(67.2%);以农村患儿为主(72.1%);临床分期以中晚期为主,其中未接种BCG组的晚期发病例数明显高于BCG组,差异有统计学意义(P<0.05);BCG组临床预后明显好于未接种BCG组,差异有统计学意义(P<0.05);两组在临床特征及是否发生脑积水方面差异无统计学意义(P>0.05).结论 BCG组晚期结核性脑膜炎的发生率较未接种BCG组低,并且其预后好于未接种BCG组.     

Tuberculous peritonitis in 11 children: Clinical features and diagnostic approach

BACKGROUND: Tuberculous peritonitis (TBP) is a rare manifestation of childhood tuberculosis characterized by long-lasting abdominal symptoms and exudate and lymphocytes in the ascitic fluid. The diagnosis of TBP is rarely established unless a high index of suspicion is maintained. METHODS: The diagnostic features of 11 cases who were hospitalized with TBP in the Pediatric Infectious Diseases Ward of Dicle University Hospital, Turkey, were evaluated retrospectively. RESULTS: Seven cases were male and the ages of all cases ranged between 1 and 11 years. The onset of symptoms was 1-12 months (mean +/- SD 3.1 +/- 2.7 months) prior to the admission time. Nine patients gave a history of familial tuberculosis. Three cases had Bacillus Calmette-Guérin (BCG) scars and the results of five tuberculin unit (TU) tests in cases without and with BCG were over 10 and 15 mm, respectively. The most common presenting clinical symptoms and signs at admission were abdominal distention and ascites (100%), fever (27%) and loss of weight (18%). One case had accompanying tuberculous meningitis and two cases had concomitant pulmonary tuberculosis. Only one of 11 samples of ascitic fluid yielded Mycobacterium tuberculosis by the polymerase chain reaction method and no other microbiologic evidence was obtained in culture specimens. Ultrasonographic and computed tomographic imagings revealed high-density ascites that contributed well to the diagnosis. The diagnosis in two patients was proven histopathologically via peritoneoscopy and laparoscopy. All cases were treated with isoniazide, rifampisin for 9 months and pyrazinamide for the first 2 months. CONCLUSIONS: Radiologic diagnostic techniques, positive skin tests and a history of exposure to tuberculosis may contribute to the diagnosis of TBP, helped by clinical symptoms and findings, particularly when invasive diagnostic methods via peritoneoscopy and laparoscopy are not available in developing countries.     

Tuberculous meningitis in children: a clinicolaboratory correlation of CSF findings for early diagnosis

Tuberculous meningitis (TBM) was commonest in children in the age group of 0–4 years (38%). The clinical diagnosis was in correlation with laboratory findings in nearly 75 percent of cases. The diagnostic difficulty of the cases in which the cytological and biochemical findings were not in correlation with clinical diagnosis of TBM could be solved by use of two simple tests. The precipitation test (modified Lavinson’s test) and tryptophane test, are simple, economical and were found specific for early diagnosis of TBM in 96 percent of cases.     

病毒性脑炎、脑膜炎多病原的探讨

为探讨北主地区病毒性脑炎及脑膜炎的病原学构成,采用微量细胞培养法,应用人胚肺二倍体细胞（ＨＥＦ）、人表此样癌细胞（Ｈｅｐ－２）、猴肾传代细胞（Ｖｅｒｏ）及狗肾传代细胞（ＭＤＣＫ）等４种细胞系对８６例脑炎、脑膜为患儿的脑脊液、粪便及咽试标本进行了病毒分离。结果３６例分离到了病毒,阳性率为４１．８６＾（３６／８６例）,其中肠道病毒３型（ＡｄＶ３）８例,单纯疱疹病毒１例（ＨＳＶ１）７例,阳性率分别为２０     

小儿病毒性脑膜炎病原诊断与临床分析

应用酶联免疫吸附（ELISA）方法,对88例临床诊断病毒性脑膜炎患儿急性期及恢复期脑脊液进行了单纯疱疹病毒（HSV－I、HSV－Ⅱ）、柯萨奇B组病毒（CoxBV）、埃可病毒（ECHO）、EB病毒（EBV）、腺病毒（AdV)及流感病毒（IFV）特异性IgM抗体检测。结果表明：HSV、CoxBV、ECHO、EBV、AdV、IFV病毒感染率分别为9．09％、18．18％、22．72％、3．41％、4．54％、5．68％;HSV及EBV感染致残率及病死率分别为87．5％（7／8）和100％（3／3）。提示脑脊液中病毒特异性IgM抗体检测可作为早期病原诊断的指标之一;CoxBV及ECH病毒是本地区小儿中枢神经系统病毒感染的主要病毒;HSV及EBV感染致残率及病死率较其它病毒高,预后不良;早期阿昔洛韦治疗,可大大降低病死率。     

γ-干扰素释放试验对儿童结核性脑膜炎的诊断价值

目的：探讨γ-干扰素释放试验(IGRAs)对儿童结核性脑膜炎的诊断价值。方法采用前瞻性病例对照研究方法,比较2012年6月至2013年12月住院的32例结核性脑膜炎患儿(TBM组)和30例非结核性颅内感染患儿(非TBM组)的IGRAs、结核菌素皮肤试验(TST)、结核杆菌抗体(TB-IgG)及脑脊液结核分枝杆菌DNA(TB-DNA)阳性率的差异,以及各指标的灵敏度、特异度、阳性预测值和阴性预测值。结果 IGRAs、TST、TB-IgG、脑脊液TB-DNA,在TBM组的阳性率分别为87.50%、56.25%、46.88%、34.38%,非TBM组为6.67%、23.33%、20%、0%,差异均有统计学意义(P<0.05)。IGRAs、TST、TB-IgG、TB-DNA的灵敏度分别为87.5%、56.25%、46.88%、34.38%,特异度分别为93.33%、76.67%、80.00%、100%,各指标灵敏度和特异度的差异均有统计学意义(P<0.05);IGRAs的灵敏度高于其他三项指标,差异均具有统计学意义(P<0.017)。IGRAs、TST、TB-IgG、TB-DNA的阳性预测值分别93.33%、72%、71.43%、100%,阴性预测值分别为87.50%、62.16%、58.54%、58.82%。结论 IGRAs、TST、TB-IgG、TB-DNA对结核性脑膜炎都具有诊断价值,IGRAs的灵敏度和特异度相对较高。     

儿童细菌性脑膜炎病原学及耐药性分析

目的了解广州地区儿童细菌性脑膜炎的病原菌分布特点及其耐药状况,为临床进行及时有效治疗提供实验室依据。方法回顾分析2005年1月—2009年12月广州妇女儿童医疗中心细菌性脑膜炎病例的脑脊液病原菌分离培养结果及其药敏试验情况。结果 5年来共从细菌性脑膜炎患儿的脑脊液标本中检出病原菌335株,其中革兰阳性菌215株(64.18%),革兰阴性菌109株(32.54%),真菌11株(3.28%)。主要是凝固酶阴性葡萄球菌(115株,占34.33%)和肺炎链球菌(81株,占24.18%)。新生儿及婴儿早期的病原菌主要是凝固酶阴性葡萄球菌。耐甲氧西林凝固酶阴性葡萄球菌发生率达55.65%。葡萄球菌对青霉素、红霉素、克林霉素耐药率超过70%,对万古霉素和利奈唑烷敏感;肺炎链球菌对青霉素耐药率为8.64%,对红霉素和克林霉素耐药率较高(>60%);革兰阴性杆菌对亚胺培南、头孢哌酮/舒巴坦及阿米卡星敏感率较高,但大肠埃希菌和肺炎克雷伯菌超广谱β内酰胺酶发生率为22.86%和27.59%。结论儿童细菌性脑膜炎主要病原菌是凝固酶阴性葡萄球菌和肺炎链球菌,早期准确的病原学诊断和及时采用敏感的抗菌药物治疗是降低后遗症发生率和病死率的重...     

Tuberculous meningitis in children

Summary Ninety cases of tuberculous meningitis have been analysed with special reference to some prognostic factors such as the age of the patient, duration of symptoms before treatment, C.S.F. picture and type of treatment. 78·8 per cent. of cases were males and 84·4 per cent. below the age of 5 years. The peak incidence was below 3 years, 21·1 per cent. of cases occurring below the age of 1 year, the youngest patient being 4 months old. History of contact could be obtained in 27·78 per cent. of cases. X-Ray chest showed evidence of intrathoracic tuberculous foci in 74·4 per cent. of cases, with miliary lesions in 15·5 per cent., hilar lymphadenopathy in 33·3 per cent., bronchopneumonic infiltration in 21·1 per cent., fibrosis in 3·3 per cent. and thickened pleura in 1·1 per cent. of cases. Out of 90 cases, 35 expired, another 35 left the hospital in an unsatisfactory state, and only 20 cases recovered, giving a satisfactory response in 22·2 per cent. of cases. The combined figures for mortality and unsatisfactory results were 82·9 per cent., 77·2 per cent. and 64·3 per cent. between the age groups 0 to 2, 2 to 5 and above 5 years respectively. 84·2 per cent. of cases with coma and/or fits either proved fatal or had severe neurological sequelae. Low cerebrospinal fluid sugar and chlorides and raised proteins affected the prognosis adversely. Treatment under “Category I, II and III” showed satisfactory response in 29·3, 50 and 11·65 per cent. of cases respectively. Steroid therapy did not seem to favourably influence the results in cases picked up at random. From the Department of Pediatrics, Medical College, Amritsar     

Tuberculous meningitis in children

Summary Of the 280 cases of tuberculous meningitis, 75.8 per cent were under 5 years of age. The males were twice as often affected as females. Testing for neck stiffness in a young febrile child is important for early diagnosis of tuberculous meningitis. Tuberculin test was negative in 18 per cent of cases. Tuberculous meningitis as a part of a miliary process occurs in a very small number of cases (2.5% in this series). The overall mortality was 24.3 per cent and sequelae were observed in 39.6 per cent of the suivivors. The prognosis with regard to mortality and neurologic sequelae, was the worst for group III patients. From the Department of Paediatrics, L.L.R.M. Medical College, Meerut.     

Tuberculous meningitis in children: problem to be addressed effectively with thorough contact tracing

Worldwide, tuberculosis is the most common cause of death from a single infectious agent in children. There has been an increase in its incidence in Europe in recent years. Early diagnosis of tuberculous meningitis in children is extremely difficult because of its nonspecific early presentation and it is universally fatal if not recognised and treated. Young children are at increased risk of acquiring tuberculosis and it is more likely to be disseminated in neonates. In summarising the cases of three children with tuberculous meningitis admitted to our centre, we highlight the importance of diagnosis and contact tracing of the source case. Conclusion Diagnosis of tuberculous meningitis requires a high index of suspicion, thorough contact tracing, and appropriate investigations with early treatment as the key to reducing morbidity and mortality. Received: 17 July 1999 and in revised form: 10 December 1999 and 24 January 2000/Accepted: 31 January 2000     

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??Objective??To explore the clinical characteristics of hydrocephalus in children with purulent meningitis. Methods??The children??aged??14 years??treated for purulent meningitis at the Shengjing Hospital of China Medical University during the period from January 2010 to December 2016??were retrospectively enrolled in the study. The clinical data of every child who fulfilled the criteria were obtained and analyzed. Data were analyzed using the Statistical Package for Social Sciences??SPSS??13.0. Results??The morbidity of hydrocephalus in children with purulent meningitis was 9.36%??25/267??. In these cases with hydrocephalus??the ageofonset was mainly under 6 months old??and the period from onset to diagnosis of hydrocephalus was mainly 1-4 weeks. Fifteen cases of hydrocephalus had a confirmed bacterial etiology as follows??Escherichia coli??n??6????Streptococcus pneumoniae??n??2????staphylococcus??n??2????Group B beta-hemolytic streptococcus??n??2????acinetobacter??n??2??and Listeria monocytogenes??n??1??. The incidence of obstructive hydrocephalus was 48%??12/25??. About 56% patients received a previously treatment with antibiotics. The prognoses of these children were??survival in 12 cases??death in 1 case and loss of follow-up in 11 cases. The related factors of the development of hydrocephalus included??a rural living situation??OR??17.64??95%CI 1.23??252.86????altered level of consciousness??OR??7.59??95%CI 1.09??52.86????CSF protein??2.0 g/L??OR??177.02??95%CI 3.53??8866.51????C-reactive protein??100 mg/L??OR??52.29??95%CI 3.26??840.19????initial therapy with dual-agent antibiotic??OR??0.06??95%CI 0.01??0.62????dexamethasone use??OR??149.47??95%CI 2.56??8713.78?? and previous treatment with antibiotics??OR??36.28??95%CI 2.84??462.78??. Conclusion??Hydrocephalus is a serious complication of purulent meningitis. The severe clinical manifestations and significantly abnormal laboratory indexes represent the most important predictor of hydrocephalus in children with purulent meningitis.     

儿童Mollaret脑膜炎3例报告并文献复习

目的 探讨MoIlaret脑膜炎(MM)的病因、发病机制、临床特征、诊断及治疗.方法 回顾性分析确诊的3例MM患儿的临床特点,并结合文献进行总结.结果 3例患儿均有发热、呕吐、头痛或惊厥、脑膜刺激征及反复多次发作的特征,抗菌、抗病毒及对症治疗后1周内能够迅速缓解.结论 Mollaret脑膜炎是临床上少见疾病,儿童病例更少,具有自限性,预后良好,提高对Mollret脑膜炎的早期识别率,可避免不必要的检查和治疗,同时应寻找与其可能相关的病因.     

结核性脑膜炎患儿阵发性交感神经过度兴奋1例报告

目的探讨继发于结核性脑膜炎的阵发性交感神经过度兴奋病例的诊断及治疗。方法回顾性分析1例继发于结核性脑膜炎患儿的临床资料。结果患儿,男,1岁,因嗜睡、呕吐入院,脑膜刺激征阳性;脑脊液检查提示颅内感染,结核菌素(PPD)试验、结核感染T细胞斑点试验(T-SPOT.TB)和影像学检查提示结核性脑膜炎。治疗期间,患儿出现血压增高、心率增快、呼吸急促、肌张力异常和高热等阵发性交感神经过度兴奋;经普萘洛尔、安坦及氯硝安定治疗后改善。结论阵发性交感神经过度兴奋是结核性脑膜炎的少见表现,早期识别可以避免误诊和过度治疗。     

Bacterial meningitis in Saudi children

During the four years period from 1988 to 1991, 50 pediatric patients were diagnosed to have bacterial meningitis, out of a total number of 9057 pediatric admissions at Qatif Central Hospital, Qatif, Saudi Arabia, and 82% were less than two years of age. The causative organisms were isolated in 27 (54%) patients. The bacteria grown includedhaemophilus influenzae type B in 8 patients (29.6%),Neisseria meningitidis in 8 patients (29.6%),Streptococcus pneumonia in 6 (22%) patients, and other bacteria in 5 patients (18.5%). Cerebro spinal fluid cultures from twenty three patients (46%) showed no organisms, however their clinical and C.S.F. findings were compatible with bacterial meningitis. One case ofH. influenzae type B was resistant to ampicillin. Six patients died with an over all mortality of 12%, and 10 patients (20%) developed some kind of C.N.S. sequelae. Partially treated meningitis formed a large percentage of our sample.     

Primary varicella zoster infection compared to varicella vaccine reactivation associated meningitis in immunocompetent children

We diagnosed varicella zoster virus (VZV) meningitis in a healthy adolescent boy who presented without a rash or fever. We aim to compare VZV reactivation meningitis in children after primary VZV infection and VZV vaccination. We reviewed the literature up until June 2020 using Pubmed/MEDLINE and EMBASE databases using ‘varicella zoster’, ‘meningitis’ and ‘children’ as keywords. Only English articles were included. Twenty‐five cases were included in this review. Children who had VZV reactivation meningitis after vaccination were younger (7 ± 3.4 years vs. 11.9 ± 3.6 years, P = 0.0038), had a shorter interval between first exposure to reactivation (5.6 ± 2.9 years vs. 8.8 ± 3.2 years, P = 0.018) and more likely to have a rash (100% vs. 55%, P = 0.04). VZV reactivation meningitis occurs after both primary VZV infection and VZV vaccination. The absence of exanthem, fever or meningism does not rule out VZV meningitis.