表皮样囊肿致Mollaret脑膜炎1例报告

Mollaret脑膜炎(mollaret meningitis,MM)又称良性复发性无菌性脑膜炎,是一种急性发作性、良性经过的无菌性脑膜炎,是一种极少见的疾病。现将我院确诊并治愈的1例MM患儿报道如下。临床资料:患儿女,8岁,主因反复发热、头痛、呕吐3年于2005年5月入院。入院前3年无明显诱因出现发热、剧烈头痛、呕吐,腰穿脑脊液检查后诊断为化脓性脑膜炎,治疗1个月症状消失,脑脊液化验正常后痊愈出院。出院后间断反复出现发热、头痛、呕吐,体检脑膜刺激征阳性,脑脊液呈典型化脓性改变,但多次脑脊液及血液细菌学检查均为阴性。以“再发性化脓性脑膜炎”先后住…     

儿童布氏杆菌脑膜炎1例并文献复习

目的 探讨布氏杆菌脑膜炎的临床特征及治疗措施.方法 布氏杆菌脑膜炎患儿1例.患儿,男,10岁.因发热、咳嗽0.5个月,头痛3d入院.家中养羊,但否认与羊密切接触.回顾性分析该患儿临床资料.检索国内外文献,进行总结分析.结果 患儿为亚急性病程,主要表现为发热、头痛和脑膜刺激征阳性,脑脊液的改变类似于结核性脑膜炎,WBC轻度升高,以淋巴细胞为主,蛋白增高,糖和氯化物降低.血清布氏杆菌抗体阳性,凝集效价为1:160.经利福平、米诺环素和头孢曲松钠三联抗生素治疗,2周后脑脊液恢复正常.出院后继续口服米诺环素、利福平和复方磺胺甲噁唑8周,恢复良好.检索国内外文献发现,儿童布氏杆菌病神经系统并发症的发生率明显低于成人,以急性脑膜炎/脑膜脑炎为主.布氏杆菌脑膜炎为亚急性病程,脑脊液改变与结核性脑膜炎类似,临床易误诊为结核性脑膜炎.本病的治疗目前主张3种抗生素联合治疗,应选用易通过血脑脊液屏障的药物,总疗程不短于8周.结论 对于儿童诊断不明的脑膜炎/脑膜脑炎,尤其表现与结核性脑膜炎类似者,应考虑布氏杆菌脑膜炎,需进行流行病学调查,并行血清凝集试验和脑脊液培养,以早期确诊.     

临床特征对儿童慢性咳嗽常见病因诊断的价值

目的 对慢性咳嗽常见病因的临床特征进行研究,分析其对各病因诊断的价值.方法 选取2008年1月 - 2009年12月门诊就诊的慢性咳嗽初诊患儿496例,按慢性咳嗽诊断程序作出慢性咳嗽初步诊断并按时随访,根据随访患儿治疗效果得出最终诊断.结果 496例患儿中感染后咳嗽(PIC)69例,咳嗽变异性哮喘(CVA)和变应性咳嗽(AC)219例,上气道咳嗽综合征(UACS)139例.CVA的临床特征主要为夜间咳嗽、干性咳嗽、特应性体质;UACS的临床特征主要为湿痰咳嗽、晨起咳嗽.结论 儿童慢性咳嗽主要病因为CVA、UACS、AC和PIC.各种病因的慢性咳嗽具有其主要的临床特征,其病因构成及临床特征可为经验性诊治慢性咳嗽提供参考.     

小儿遗传性高氨血症三例临床和头颅MRI影像学特点

目的：探讨小儿遗传性高氨血症的病因、临床及影像学特征。方法对3例临床诊断为高氨血症患儿的临床表现、头MRI影像学、治疗等进行分析。结果3例高氨血症患儿均行遗传代谢病筛查明确病因为鸟氨酸氨甲酰基转移酶缺陷、瓜氨酸血症、甲基丙二酸血症,3例患儿临床表现差异较大,其中2例患儿早期行头颅MRI检查,弥散加权成像均提示高信号。早期积极对症治疗,1例患儿治疗效果较好。另2例患儿治疗效果差。结论对高氨血症患儿早期寻找病因,早期干预,对预后的判断至关重要。头MRI对高氨血症患儿的病因学判断有重要意义。     

新生儿B族链球菌败血症临床分析

目的探讨新生儿B族链球菌（GBS）败血症的临床特征。方法对2011年1月至2012年12月收治确诊的21例新生儿GBS败血症患儿临床表现、治疗和转归进行回顾性分析、总结。结果21例GBS感染患儿中,男12例,女9例;早产儿3例,足月儿18例;早发型GBS败血症患儿5例,3例无发热,2例因“高热”起病者均合并化脓性脑膜炎。晚发型GBS败血症患儿16例,其中15例主要症状为高热,确诊化脓性脑膜炎7例。21例患儿中1例因出生窒息合并症放弃治疗,3例转诊外院继续治疗,余17例患儿住院治疗时间为14—46d。结论新生儿早发型GBS感染多在24h内起病,首发症状可为呼吸窘迫、高胆红素血症或发热,晚发型多以高热起病且易合并化脓性脑膜炎,病情凶险,临床多采用青霉素联合三代头孢菌素治疗,治疗效果满意。     

新生儿重症化脓性脑膜炎临床特征分析

目的:探讨新生儿重症化脓性脑膜炎的临床特征。方法:回顾性选取2014年1月至2017年12月本院新生儿疾病诊治中心诊断的169例化脓性脑膜炎患儿为研究对象,依据病情轻重分为重症组及普通组,收集所有患儿临床资料并统计分析,总结重症化脓性脑膜炎的特征。结果:169例患儿中,重症组43例(25.4%),普通组126例(74....     

新疆自治区人民医院PICU婴幼儿结核性脑膜炎17例分析

目的 通过对PICU收住结核性脑膜炎患儿早期临床特点的分析,探讨婴幼儿结核性脑膜炎的早期临床诊断方法.方法 回顾性分析新疆自治区人民医院2011至2012年收治的17例婴幼儿结核性脑膜炎患儿的病历资料.结果 17例患儿中,16例（94％）伴有发热及意识障碍;脑脊液检查呈较典型改变者14例（82.35％）;头颅MRI检查结果异常12例（71％）,脑室扩大10例（83％）;而腺苷脱氨酶增高仅4例（24％）;结核抗体阳性1例（6％）;PPD试验阳性2例（12％）.结论 婴幼儿结核性脑膜炎早期临床症状缺乏特异性.脑脊液葡萄糖、氯化物降低;蛋白升高.头颅MRI或CT异常.胸部X线改变,有结核接触史等依据可协助诊断,脑脊液腺苷脱氨酶、乳酸脱氢酶并不比蛋白和氯化物更有意义.临床上可疑结核性脑膜炎患儿或不典型化脓性脑膜脑炎治疗效果欠佳时,应在积极寻找结核感染证据的同时尽早开始抗结核治疗.     

儿童假性巴特综合征9例临床分析

目的 探讨儿童假性巴特综合征(Pseudo-Bartter syndrome,PBS)的临床特征及实验室检查特点,提高临床医师对本病的认识.方法 收取首都医科大学附属北京儿童医院2008年11月至2013年9月收治的PBS患儿9例,对患儿的临床表现、辅助检查及治疗等相关临床资料进行回顾性分析.应用SPSS 19.0软件分析数据.结果 1.临床特征:本组病例共9例,其中女4例,男5例;就诊年龄4个月～8岁8个月.引起PBS的原因以呼吸道感染引起的消化道症状(如腹泻、呕吐)(7/9例)最为多见.6例患儿无明显临床表现,治疗原发病过程中发现低钾血症.2.实验室检查:均存在低钾低氯血症、不同程度的代谢性碱中毒及肾素、血管紧张素及醛固酮升高.3.治疗:在病因控制治疗、补钾对症治疗或吲哚美辛治疗[1 mg/(kg·d),分3次口服]后,患儿均达到临床好转且血电解质均恢复正常.在停补钾对症治疗后,血电解质仍正常,随访期限5～7d.结论 1.在中国儿童中,引起PBS最常见的原因以呼吸道感染所致的呕吐、腹泻等最为多见.2.儿童PBS除了病因相关的临床表现外,多无明显临床表现,常于实验室检查中偶然发现低钾血症.3.儿童PBS实验室检查表现为低钾低氯血症、代谢性碱中毒,其肾素、血管紧张素及醛固酮水平均明显升高.4.儿童PBS经祛除病因及补钾对症治疗,通常2～4d电解质恢复正常.     

小儿化脓性脑膜炎临床和病因学分析

目的探讨化脓性脑膜炎的病因,为诊治提供科学依据。方法收集住院化脓性脑膜炎患儿371例,男252例,女119例;平均年龄(2.67±3.32)岁。对患儿临床表现及血液和脑脊液(CSF)相关参数进行分析。结果 371例中≤1岁患儿占46.36%,<3岁占80.59%,以发热(90.29%)、抽搐(52.56%)等症状就诊。82.21%患儿白细胞计数(WBC)>10×109/L,74.42%患儿中性粒细胞比率>50%,85.44%患儿脑脊液WBC≥500×106/L。血培养革兰染色阳性(GSP)37例,革兰阳性菌(GPB)24例,革兰阴性菌(GNB)13例。脑脊液培养阳性34例,GPB 19例,GNB 15例。脑脊液检测出肺炎链球菌8例,流感嗜血杆菌3例,奈瑟菌1例。死亡7例(1.88%)中,脑脊液2例GNB阳性,5例化脓性/混浊,4例蛋白>150 mg/dl和葡萄糖<1 mg/dl。结论化脓性脑膜炎的发病年龄多在婴幼儿阶段,临床表现多种多样,血液和脑脊液相关参数分析,能较好的提供病因诊断依据,并为临床治疗及预后提供参考。     

儿童屎肠球菌脑膜炎的临床特征分析

目的 总结屎肠球菌脑膜炎患儿的临床特点,以期提高临床诊治水平。方法 对9例屎肠球菌脑膜炎患儿进行临床资料分析。结果 9例患儿均经血液或脑脊液或PICC端培养出屎肠球菌,其中6例（67%）为新生儿,2例（22%）为6个月以内婴儿,1例（11%）为3岁4个月幼儿。56%的患儿起病前存在致病高危因素：肠道感染、脑积水术后安置引流管,以及颅骨骨折、导管相关性感染和母亲围产期感染。以发热、反应差为主要表现,22%的患儿出现抽搐,均无脑膜刺激征及意识障碍。血常规白细胞总数及CRP正常或升高;脑脊液有核细胞正常或轻度升高,蛋白明显升高,糖降低。药敏均提示对万古霉素敏感,且万古霉素治疗有效,1例出现脑积水并发症。结论 屎肠球菌脑膜炎主要见于新生儿及婴儿,存在致病高危因素的比例高,临床特征不典型,对万古霉素敏感。     

Mollaret meningitis associated with an intraspinal epidermoid cyst

Mollaret meningitis, a benign recurrent aseptic disease, is known to be associated with intracranial epidermoid cysts. In this report, we describe a case of Mollaret meningitis caused by an intraspinal epidermoid cyst located at thoracic level 12. The patient's clinical manifestations and cerebrospinal fluid features were similar to those with bacterial meningitis characterized by predominant polymorphonuclear leukocytes. However, Mollaret cells, not bacteria, were identified in the patient's cerebrospinal fluid. The illness ceased after surgical resection of the cyst, and the cyst tissue was pathologically diagnosed as epidermoid. Therefore, an intraspinal epidermoid cyst can be etiologically associated with Mollaret meningitis and should be included in the differential diagnosis of recurrent aseptic meningitis.     

Pneumococcal meningitis in the newborn period in a prevaccination era: a 10-year experience at a tertiary intensive care unit

There are few data with respect to pneumococcal meningitis in neonates. Epidemiological aspects, clinical features and outcomes in newborn infants diagnosed with pneumococcal meningitis were evaluated in this study. Nineteen newborn infants in a neonatal intensive care unit diagnosed with culture-proven community-acquired bacterial meningitis between January 1999 and December 2008 were reviewed, and of them, eight patients were diagnosed as pneumococcal meningitis. Overall, among 10,186 hospitalized newborn infants, 132 community-acquired sepsis/meningitis cases (1.3%) were suspected, and blood cultures were performed in all, while cerebrospinal fluid (CSF) cultures could be performed in 124 cases. Rate of blood culture positivity was 45%. Nineteen (15.3%) of 124 were diagnosed as culture-proven community-acquired bacterial meningitis, which was confirmed by CSF growth. Eight (42.1%) of 19 had pneumococcal meningitis. In pneumococcal cases, abundant Gram-positive diplococci were seen on CSF smear and Streptococcus pneumoniae was isolated from CSF cultures. All isolates were susceptible to penicillin and third-generation cephalosporins. Irritability (n: 7), poor sucking (n: 7) and fever (n: 6) were the principal findings on the initial physical examination. Of all patients with pneumococcal meningitis, four were initially given cefotaxime plus amikacin treatment, and the remaining four were initially given cefotaxime plus ampicillin plus vancomycin. Antibiotic treatment in two patients was revised during their clinical course. Additionally, in three patients, vancomycin and ampicillin was discontinued on the third day when antibiogram of CSF cultures revealed penicillin sensitivity. Overall, mortality in pneumococcal meningitis was 50%. In the surviving patients, two had epilepsy, one sensorineural hearing loss, and two mental-motor retardation. Pneumococcal meningitis was the leading cause of community-acquired neonatal meningitis in our patients. Immunization against pneumococcal disease in developing countries would be beneficial for public health and for newborn infants.     

Mollaret's meningitis due to human herpesvirus 6 in an adolescent

We report the first pediatric case of Mollaret meningitis in an adolescent female with acute lymphoblastic leukemia in remission. This patient had signs and symptoms consistent with meningitis, with three episodes over a 3-month period. Human herpesvirus 6 (HHV-6) was identified during her last episode from polymerase chain reaction assay of a cerebrospinal fluid specimen. She was treated successfully with foscarnet, after which HHV-6 was undetectable in her cerebrospinal fluid.     

Haemophilus cellulitis--a contribution to the differential diagnosis of cheek swelling in childhood

The Haemophilus influenzae cellulitis in infancy is a disease with special features in relation to early clinical recognition and treatment. We describe three such cases seen in our hospital with Haemophilus influenzae as etiological agent. One patient died in consequence of a purulent meningitis recognized not in time and developing under antibiotic therapy not suitable for H. i. cellulitis. After review of the most important data from the literature suggestions were made for adequate diagnostic and therapeutic procedures in patients with H. i. cellulitis.     

儿童化脓性脑膜炎不良预后危险因素探讨

目的探讨影响化脓性脑膜炎不良预后的危险因素。方法对2007年1月—2008年12月在北京儿童医院感染病房临床诊断的化脓性脑膜炎148例患儿进行系统回顾分析,采用t检验和卡方检验及Logistic回归分析方法,根据Glasgow临床结局评分标准比较预后良好组与预后不良组在病史、临床表现、并发症、辅助检查、治疗等方面的异同。结果发热、精神反应差、抽搐是化脓性脑膜炎患儿最常见的临床表现,单变量回归分析提示住院时间、瞳孔对光反射减弱、瞳孔不等大、血白细胞计数<4×109/L或>12×109/L、脑脊液糖≤1.5 mmol/L、脑脊液蛋白>1 000 mg/L、血钠<135 mmol/L和血钙在两组间差异有统计学意义;而年龄、性别、抗生素应用、激素治疗等与预后无明显相关。多变量分析发现,住院时间、瞳孔不等大、入院时末梢血白细胞计数、脑脊液糖和蛋白水平、血钠对预后有指示意义。结论影响化脓性脑膜炎不良预后的危险因素是瞳孔不等大、入院时白细胞计数<4×109/L或>12×109/L、脑脊液糖≤1.5 mmol/L、脑脊液蛋白>1 000 mg/L、血钠<135 mmol/L。对有预后不良因素者进行更为积极有效的治疗可以在一定...     

Seizures and fever: can we rule out meningitis on clinical grounds alone?

A study was done of 309 children seen in two ERs with a first seizure and fever to assess whether meningitis could be recognized using readily available clinical information. Among these children, 23 (7%) cases of meningitis were diagnosed. A group of 69 children with seizures and fever but no meningitis served as controls. Signs from ER examinations that discriminated between children with and those without meningitis were: petechiae, nuchal rigidity, coma, persistent drowsiness, ongoing convulsions, and paresis or paralysis; 21 cases were thus identified. Two children with a suspicious history but none of these signs proved to have meningitis. Children whose seizures showed no complex features and whose febrile illness revealed no suspicious features did not have meningitis. Our results indicate that based on available clinical data, meningitis can be ruled out in children presenting with seizures and fever; thus, there is no need for routine investigation of cerebrospinal fluid.     

Fever as a sign of central nervous system infection

Over the past decade, there has been a variety of changes in the epidemiology and management of central nervous system (CNS) infection in children. With the rapid decline of invasive Haemophilus influenzae type b disease, Streptococcus pneumoniae is now the most prominent pathogen responsible for bacterial meningitis in children 1 to 23 months. The emergence of penicillin-resistant pneumococcal disease has led to the recommendation of empiric vancomycin and either ceftriaxone or cefotaxime for all children older than 1 month with probable or definite bacterial meningitis. Use of adjunctive dexamethasone therapy has proven beneficial in HIB meningitis and a beneficial effect I MS been suggested in pneumococcal meningitis. Fluid restriction as a routine to treat presumptive syndrome of inappropriate antidiuretic hormone in acute meningitis does not appear to improve outcome in hospitalized children. In addition, newly available diagnostic modalities allow more specific diagnosis and treatment of aseptic meningitis and encephalitis. This article reviews the three most common causes of CINS infection in the pediatric population which are meningitis, brain abscess, and encephalitis. Emphasis is placed on clinical features, diagnostic evaluation, and appropriate treatment of patients with suspected CNS infection. Early recognition and presumptive treatment of suspected CNS infection could limit neurological damage, exerting a positive impact on final outcome. Clinicians must he knowledgeable of emerging diseases, developing diagnostic trends, and new therapeutic options to provide quality patient care.     

A diagnostic rule for tuberculous meningitis.

Diagnostic confusion often exists between tuberculous meningitis and other meningoencephalitides. Newer diagnostic tests are unlikely to be available in many countries for some time. This study examines which clinical features and simple laboratory tests can differentiate tuberculous meningitis from other infections. Two hundred and thirty two children (110 tuberculous meningitis, 94 non-tuberculous meningitis, 28 indeterminate) with suspected meningitis and cerebrospinal fluid (CSF) pleocytosis were enrolled. Tuberculous meningitis was defined as positive CSF mycobacterial culture or acid fast bacilli stain, or basal enhancement or tuberculoma on computed tomography (CT) scan with clinical response to antituberculous treatment. Non-tuberculous meningitis was defined as positive CSF bacterial culture or Gram stain, or clinical response without antituberculous treatment. Thirty clinical/laboratory features of patients with tuberculous meningitis and non-tuberculous meningitis were compared by univariate and multiple logistic regression analysis. Five features were independently predictive of the diagnosis of tuberculous meningitis (p < 0.007): prodromal stage >/= 7 days, optic atrophy on fundal examination, focal deficit, abnormal movements, and CSF leucocytes < 50% polymorphs. When validated on another set of 128 patients, if at least one feature was present, sensitivity was 98.4% and, if three or more were present, specificity was 98.3%. This simple rule would be useful to physicians working in regions where tuberculosis is prevalent.     

细菌性脑膜炎并脑积水的临床特点及危险因素

目的探讨细菌性脑膜炎并脑积水的临床特点,并分析其相关的危险因素,以降低其发生率,改善细菌性脑膜炎的预后。方法对2004年1月-2010年6月本院收治的111例细菌性脑膜炎患儿的临床资料进行回顾性分析。根据影像学结果,将患儿分为细菌性脑膜炎并脑积水组(n=16)及细菌性脑膜炎无脑积水组(n=95),应用SPSS 17.0软件对2组患儿的基本情况、临床表现、实验室结果及抗生素治疗情况等进行比较,对相关因素进行Logistic回归分析,筛选出脑积水发生的高危因素。结果细菌性脑膜炎并脑积水的发生率为14.4%(16/111例),以梗阻性脑积水为主(14/16例,87.5%),75%(12/16例)患儿脑积水出现在起病4周内,确诊时CT/MRI的检查次数为1～3次,2例患儿在起病后2个月行脑室-腹腔分流术,2例脑积水患儿死亡。2组临床资料比较显示年龄、发热>10 d、惊厥、意识障碍、经验性治疗失败、颅内低密度灶、低Hb水平、高脑脊液蛋白水平、低脑脊液葡萄糖水平均与脑积水发生有关(Pa<0.05),Logistic回归分析显示意识障碍、经验性治疗失败、低Hb水平是细菌性脑膜炎并脑积水的独立危险因素。结论脑积水是细菌性脑膜炎的一个严重并发症之一,临床表现及实验室检查结果可作为细菌性脑膜炎并脑积水的预测指标。     

Recrudescence and relapse of meningococcal meningitis and septicaemia

Three cases of recrudescence and relapse of Neisseria meningitidis group B meningitis and septicaemia are reported. The recrudescence and relapses could not be explained by infectious foci, increased bacterial penicillin resistance or immunological defects. As a supplement to antibiotic treatment, all three patients received corticosteroids for the initial 2 days of treatment, and this may have contributed to the unusual course of the disease in our patient.