尿路感染合并无菌性脑膜炎1例报告及文献复习

目的探讨尿路感染合并无菌性脑膜炎的临床特点、发病机制及诊治,以提高对此疾病的认识。方法分析1例尿路感染合并无菌性脑膜炎患儿的临床特点和实验室检查结果,并复习相关文献。结果患儿2月龄,临床表现为发热、颈抵抗及前囟隆起,伴有尿道口充血及异常分泌物。脑脊液白细胞计数30×106/L。患儿血培养、脑脊液培养均阴性。尿培养为屎肠球菌生长。经静脉抗感染治疗10 d,病情好转,随访病情无复发。结论尿路感染患儿可合并无菌性脑膜炎,其机制可能与细菌感染引起脑膜炎症反应有关,临床上需与细菌性脑膜炎进行鉴别,如明确为前者可适当缩短抗感染疗程。     

新蝶呤和S100b在诊断儿童中枢神经系统感染中的价值

目的 研究脑脊液中新蝶呤（NPT）、S100b水平在诊断儿童中枢神经系统感染中的价值。方法 采用ELISA法测定中枢神经系统感染患儿脑脊液NPT及S100b浓度,对比感染及非感染患儿之间指标的异同,并采用ROC法评价两种指标的诊断价值。结果 病毒性脑炎患儿脑脊液中NPT及S100b浓度较对照组及化脓性脑膜炎患儿明显升高,差异有统计学意义（PP>0.05）,但化脓性脑膜炎患儿S100b水平明显高于对照组（P结论 NPT及S100b在儿童中枢神经系统感染的诊断中有一定的价值,且在诊断病毒性脑炎中作用明显,尤以S100b指标为佳。     

Bacteroides fragilis concealed in an infant with Escherichia coli meningitis

Anaerobic meningitis in infants is rare, therefore a high index of clinical suspicion is essential as routine methods for processing cerebrospinal fluid (CSF) do not detect anaerobes and specific antimicrobial therapy is required. We present an infant with Escherichia coli meningitis where treatment‐resistance developed in association with culture negative purulent CSF. These features should have alerted us to the presence of anaerobes, prompting a search for the causes of polymicrobial meningitis in infants.     

Streptococcus gallolyticus subsp. pasteurianus meningitis in an infant

Streptococcus gallolyticus subsp. pasteurianus was formerly classified as S. bovis biotype II/2, which is recognized as a rare cause of neonatal sepsis and meningitis. Since the taxonomy classification change, there have not been many reports of meningitis due to S. gallolyticus subsp. pasteurianus. Moreover, the pathogenesis of late onset S. gallolyticus subsp. pasteurianus meningitis in infants is unclear. Here we report a case of meningitis in a 5‐week‐old infant with preceding diarrhea. S. bovis biotype II/2 was isolated from the blood, cerebrospinal fluid and stool, and then was identified as S. gallolyticus subsp. pasteurianus on 16S rRNA gene sequencing. Isolates from all three sample types had identical profiles on pulsed‐field gel electrophoresis. The intestinal tract was thought to be the source of the infection.     

Bacterial meningitis after radiofrequency diathermy for adenoid hypertrophy

A 6‐year‐old otherwise healthy girl who underwent radiofrequency diathermy for adenoid hypertrophy presented with fever on the same day and was diagnosed as having bacterial meningitis 2 days later. Culture of cerebrospinal fluid indicated that the pathogens were penicillin‐sensitive Streptococcus pneumoniae and methicillin‐sensitive Staphylococcus aureus. The serotype of the causative pneumococcus, 11A, was not covered by the 7‐valent pneumococcal conjugate vaccine the patient had been inoculated with. Although not previously reported, radiofrequency diathermy for adenoid hypertrophy can be considered a risk factor for bacteremia and meningitis.     

Presentation and outcome of tuberculous meningitis among children: experiences from a tertiary children's hospital

Background

Diagnosis of tuberculous meningitis (TBM) is complicated and outcome is poor especially in resource limited settings. Early diagnosis and prompt treatment are vital in effective treatment. We set out to describe experiences in the management and immediate outcome of TBM a tertiary-level children''s hospital in a high HIV and tuberculosis co-infection setting.

Methods

This retrospective study included children who were diagnosed with TBM in the year 2009. A pre-coded questionnaire was used to extract data on presentation, diagnostics, treatment and outcome at the time of hospital discharge. Data was analyzed using STATA statistical package (StataCorp, Version 11).

Results

Of the 40 children diagnosed with TBM, 6 (15%) had definitive TBM, 17 (42.5%) had probable TBM and 17 (42.5%) had possible TBM. The cerebrospinal fluid (CSF) chemistry and cells were abnormal in 39/40 (98%). Mantoux test was reactive in 16/29 (55%) and 17/30 (57%) had Chest X-rays suggestive of tuberculosis. Only 3/21 (14%) had positive sputum tuberculosis culture and 89% (32/36) had neuro-imaging abnormalities. Outcome at discharge was; 8% died, 49% improved with neurological sequelae and 43% improved without sequelae. Having TBM stage 3 at admission was associated with mortality (p=0.001).

Conclusions

Most children had early diagnosis of TBM and mortality was lower than in previous studies. We recommend a larger prospective study to further understand the outcome of TBM.     

Dexamethasone downregulated the expression of CSF 14-3-3β protein in mice with eosinophilic meningitis caused by Angiostrongylus cantonensis infection

Angiostrongylus cantonensis is the main causative agent of human eosinophilic meningitis in Southeast Asia and the Pacific Islands. A previous study demonstrated that the 14-3-3β protein is a neuropathological marker in monitoring neuronal damage in meningitis. Steroids are commonly used in patients with eosinophilic meningitis caused by A. cantonensis infection. However, the mechanism by which steroids act in eosinophilic meningitis is unknown. We hypothesized that the beneficial effect of steroids on eosinophilic meningitis is partially mediated by the down-regulation of 14-3-3β protein expression in the cerebrospinal fluid (CSF). In this animal study, we determined the dynamic changes of 14-3-3β protein in mice with eosinophilic meningitis. The 14-3-3β protein in serum and CSF was increased in week 2 and 3 after infections. Dexamethasone administration significantly decreased the amounts of CSF 14-3-3β protein. By developing an in-house ELISA to measure 14-3-3β protein, it was found that the amounts of 14-3-3β protein in the CSF and serum increased over a three-week period after infection. There was a remarkable reduction of 14-3-3β protein in the CSF after 2 weeks of dexamethasone treatment. In conclusion, the administration of corticosteroids in mice with eosinophilic meningitis decreased the expression of 14-3-3β protein in the CSF.     

儿童隐球菌性脑膜炎误诊为结核性脑膜炎24例分析

目的 分析儿童隐球菌性脑膜炎临床特点及误诊原因,降低误诊率.方法 回顾性分析24例误诊为结核性脑膜炎的隐球菌性脑膜炎患儿临床资料.结果 24例中男童14例,女童10例,平均年龄(7.5±3.8)岁,主要临床表现为发热(100％)、头痛(87.5％)、呕吐(87.5％).院外误诊15例(62.5％),院内误诊9例(37....