Mondini dysplasia with recurrent bacterial meningitis caused by three different pathogens

Mondini dysplasia is rare, but has an important association with recurrent bacterial meningitis. We herein describe the case of a 3‐year‐old girl with unilateral sensorineural hearing loss who presented with three independent episodes of bacterial meningitis within 8 months. Temporal bone computed tomography indicated the characteristic features of Mondini dysplasia in the right inner ear. This was treated by surgical closure of the inner ear defect via oval window and additional vaccination was administered. Appropriate vaccination might prevent the recurrent bacterial meningitis associated with Mondini dysplasia.     

孟鲁司特联合鼻内激素治疗儿童腺样体肥大的临床观察

目的观察孟鲁司特联合鼻内激素治疗儿童腺样体肥大的短期疗效。方法选取腺样体肥大患儿47例,随机分成2组。联合用药组23例,采用孟鲁司特与鼻内激素联合治疗;对照组24例,单用鼻内激素治疗;连续治疗2个月。根据纤维鼻咽镜检查和改进的Bitar临床评分方法比较两组疗效。结果联合用药组治疗2周和2个月的临床评分分别为0(0,1.0);0(0,0),优于对照组的临床评分1.0(1.0,1.0);0(0,1.0),差异具有统计学意义(Z=2.404、2.069,P均<0.05)。结论孟鲁司特联合鼻内激素治疗腺样体肥大的疗效优于单纯使用鼻内激素。     

Varicella infection complicated with meningitis after immunization

A healthy 45 month old boy who had received varicella vaccine 21 months previously developed aseptic meningitis along with an episode of varicella. The presence of viral DNA in cerebrospinal fluid (CSF) detected by polymerase chain reaction (PCR) with Southern blot hybridization confirmed the relationship between the symptoms and the CSF pleocytosis. This is the first reported case of this complication of varicella meningitis occurring in a child with documented immunization and seroconversion.     

儿童细菌性脑膜炎95例病原菌分布和预后分析

目的了解儿童细菌性脑膜炎(BM)病原菌分布、细菌耐药性、临床特征和预后。方法回顾分析2011年1月至2015年7月期间住院治疗的病原体明确的BM患儿的临床资料。按出院时结局将患儿分为结局良好和结局不良组。分析比较各组患儿的病原菌分布、细菌耐药性、临床特征及预后。结果共纳入95例病原体明确的BM患儿,其中69例(72.6%)为革兰阳性菌,以肺炎链球菌(43例,45.3%)占首位;26例为革兰阴性菌(27.4%),以大肠埃希菌(13例,13.7%)占首位。肺炎链球菌和大肠埃希菌对青霉素的耐药率均超过了50%。BM患儿神经系统并发症包括硬膜下积液、脑积水、脑实质损伤,以及听力和视力损伤等。多元logistic回归分析显示,意识障碍、昏迷、脑脊液葡萄糖水平低下是BM患儿出院时不良结局的独立危险因素。结论儿童BM的病原体以肺炎链球菌和大肠埃希菌为主,对青霉素的耐药率高。BM患儿可出现不同程度的神经系统后遗症,意识改变和异常以及脑脊液葡萄糖水平低下提示患儿出院时不良结局。     

儿童细菌性脑膜炎100例病原分布及耐药分析

目的了解细菌性脑膜炎(BM)患儿致病菌分布、耐药情况和临床特点。方法回顾性分析2004年3月至2015年3月脑脊液(CSF)培养阳性BM患儿的临床资料,并按年龄分新生儿组(0~28 d)、婴儿组(~1岁)、儿童组(≥1岁),按发病时间分早年组(2004年3月—2010年3月)和近年组(2010年4月—2015年3月),按临床病因分为外伤手术继发感染组和对照组进行比较分析。结果共100例患儿,检出102株病原菌,革兰阳性菌62株(60.8%),革兰阴性菌40株(39.2%)。主要致病菌依次为肺炎链球菌(33株)、大肠埃希菌(22株)、无乳链球菌(10株)。近年组无乳链球菌所占比例为18.8%(9例),高于早年组的1.9%(1例),差异有统计学意义(χ~2=6.406,P=0.011)。外伤手术继发感染组凝固酶阴性葡萄球菌比例高于对照组,差异有统计学意义(χ~2=6.631,P=0.010)。药敏分析发现,对照组中60.0%大肠埃希菌产超广谱β-内酰胺酶(ESBLs),外伤手术继发感染组的唯一1例大肠埃希菌ESBLs阴性。两不同病因组中肺炎链球菌对万古霉素、利奈唑胺均敏感。外伤手术继发感染组肺炎链球菌对青霉素耐药率为66.7%,对照组为45.8%,两组间差异无统计学意义(P0.05)。无乳链球菌均发生在对照组,对青霉素、利奈唑胺均敏感,而万古霉素敏感率仅为70%。新生儿组、婴儿组和儿童组并发症发生率分别为55.0%(22/40)、78.6%(33/42)和33.3%(6/18),差异有统计学意义(χ~2=11.848,P0.05)。三个年龄段最常见的急性期并发症分别为脑室扩张(40.9%)、硬膜下积液(45.5%)、脑积水(40.0%)。治愈35例,好转出院41例,未愈自动出院22例,死亡2例。结论儿童BM病原菌以肺炎链球菌、大肠埃希菌、无乳链球菌为主,近年无乳链球菌感染有所增加,不同年龄组的并发症有所不同。     

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。     

Adverse reactions to simultaneous influenza and pneumococcal conjugate vaccinations in children: randomized double-blind controlled trial

In a randomized double-blind controlled trial, the safety was assessed of simultaneous administration of influenza and pneumococcal conjugate vaccines in children with previous physician-diagnosed respiratory tract infections. In total, 579 children aged 18–72 months were assigned to receive simultaneous intramuscular influenza and pneumococcal heptavalent conjugate vaccinations (IV + PV), influenza and placebo vaccinations (IV + plac) or control hepatitis B and placebo vaccinations (HepB + plac) in separate extremities. Local and systemic adverse events were recorded in parental diaries for 7 days after vaccination. No immediate adverse reactions were recorded. In most children local adverse reactions disappeared 2 days after vaccination. Local and systemic reactions were more prevalent (30% and 10% more) in the IV + PV group compared with the IV + plac and HepB + plac group. These results are important for designing future vaccination schedules.     

细菌性脑膜炎并硬膜下积液的相关因素

目的 探讨细菌性脑膜炎并硬膜下积液的因素,减少、预防硬膜下积液的发生.方法 收集在本院住院的细菌性脑膜炎患儿88例,入院后予抗感染、脱水降颅压、退热、止惊等处理,完成影像学检查及腰椎穿刺术,检测血生化、脑脊液等.观察并追踪随访到患儿出院后0.5a,按是否并硬膜下积液分为硬膜下积液组及对照组.定期收集2组患儿相关检查和临床资料,应用相关分析等统计学方法探讨硬膜下积液发生的相关因素.结果 二组间CRP(t =2.469,P=0.016)、降钙素原(PCT)(t=2.172,P=0.034)及脑脊液蛋白(t =2.729,P=0.008)差异均有统计学意义.简单相关分析发现脑脊液蛋白与病程(r=0.642,P =0.045)、ESR(r=0.737,P=0.037)中度相关,脑脊液蛋白与CRP(r=0.924,P=0.008)、PCT(r=0.912,P=0.024)高度相关,脑脊液糖与脑脊液蛋白呈负相关(r=-0.655,P=0.040).等级相关分析发现CRP(Kendall's相关系数为0.707,P=0.020;Spearman's相关系数为0.822,P =0.007)、PCT( Kendall’s相关系数为0.687,P=0.040;Spearman's相关系数为0.762,P=0.031)、脑脊液蛋白(Kendall's相关系数为0.699,P=0.019;Spearman's相关系数为0.782,P=0.007)与硬膜下积液中度相关,ESR(Kendall's相关系数为0.442,P=0.032;Spearman's相关系数为0.514,P=0.023)与硬膜下积液低度相关.脑脊液糖、氯化物等与硬膜下积液无相关性(Pa＞0.05).结论 细菌性脑膜炎并硬膜下积液具有更高的炎性反应,临床上需注意减轻炎性反应、减少渗出以预防硬膜下积液.     

社区获得性急性细菌性脑膜炎患儿的管理

细菌性脑膜炎(BM)是小儿常见的神经系统感染性疾病之一,常影响小儿精神运动发育,其正确的诊断和治疗一直是个挑战;美国、欧洲、加拿大、法国、英国先后于2004 - 2010年发布了BM治疗指南,对于指导临床医师处理BM有重要的参考价值.     

Low-dose acyclovir for HSV-2 meningitis in a child

A 7-y-old girl with genital herpes following sexual abuse presented with dysuria, fever and meningeal signs. Acyclovir (15 mg/kg/d for 10 d) was administered for severe genitourinary symptoms. The CSF culture was positive for HSV type 2. Complete resolution of all symptoms demonstrates that, as in adults, HSV-2 meningitis does not require high-dose or prolonged acyclovir therapy.     

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...