结核性脑膜炎患者死亡危险因素分析

目的：探讨结核性脑膜炎患者死亡的相关因素。方法收集2011~2014年收治的结核性脑膜炎病例,回顾性分析与死亡密切相关的危险因素。结果144例患者入选,死亡48例,死亡组平均生存时间50.8天(1~177天),50%患者死于入院30天内。死亡患者和生存的患者的临床特征有明显不同,与死亡相关的独立危险因素有年龄>80岁,MBI≤12,脑积水和 BMRC Ⅲ级。结论 TBM死亡患者在临床特点和影像学表现上有特征,高龄、严重营养不良、脑积水及结脑分级为BMRC Ⅲ级者有较高的死亡率。     

结核性脑膜炎鞘内注射疗法的临床观察与对策

目的：归纳总结结核性脑膜炎早期联合鞘内注射治疗方法,探索鞘内注射疗法患者的有效护理方法.方法：对35例早期联合鞘内注射治疗的结核性脑膜炎患者的辨证施护进行回顾性横断面研究.结果：通过密切观察、及时给药、做好术前心理干预、术中心理支持、术后的心理、饮食、体位及皮肤辨证施护.35例结核性脑膜炎患者取得了良好的治疗和护理效果.结论：鞘内注射是一种有创治疗方法,在整个治疗过程中,临床观察、心理,饮食、体位及皮肤等辨证施护也是治疗成功与否的关键.     

Systematic review of invasive Acinetobacter infections in children

INTRODUCTION:

Clinicians are generally familiar with Acinetobacter as an etiological agent for serious nosocomial infections in intensive care units. However, there are no previous reviews of the full spectrum of invasive infections in children.

METHODS:

A systematic review of the literature was completed up to December 2008 for reports of invasive Acinetobacter infections in children.

RESULTS:

There were 101 studies that met the inclusion criteria including 18 possible outbreaks, 33 case series and 49 case reports. Suspected outbreaks were concentrated in neonatal intensive care units (16 of 18 outbreaks) and involved bacteremia or meningitis. Proof of isolate clonality or identification of the source of the outbreak was seldom established. Case series were primarily of children younger than five years of age presenting with bacteremia (sometimes multiresistant), meningitis, endocarditis or endophthalmitis, with many community-acquired infections being reported from India. Case reports consisted of unique presentations of disease or the use of novel therapies. Attributable mortality in the outbreaks and case series combined was 68 of 469 (14.5%).

DISCUSSION:

Invasive Acinetobacter infections in children usually manifest as bacteremia, meningitis or both, but can result in a wide variety of clinical presentations. Outbreaks are primarily a problem in newborns with underlying medical conditions. Most reports of community-acquired infections are from tropical countries. The study of the mechanism of colonization and infection of children in intensive care units and of neonates in tropical countries may provide some insight into prevention of invasive infections.     

利奈唑胺治疗耐多药肺结核合并结核性脑膜炎1例临床分析

<正>耐药结核病,尤其是耐多药结核病([1]MDR-TB)为难治性结核病,临床应用利奈唑胺联合其他药物治疗MDR-TB及广泛耐药结核病(XDR-TB)取得较好疗效[2],但对其用于耐多药肺结核合并结核性脑膜炎的治疗少见报道。笔者临床采用利奈唑胺治疗MDR-TB合并结核性脑膜炎、并在耐多药方案化疗过程中出现病情恶化患者1例,现结合国内外研究进展进行回顾性分析如下。     

Cerebrospinal fluid ferritin — Unspecific and unsuitable for disease monitoring

Background and purposeSubarachnoid hemorrhage is sometimes difficult to diagnose radiologically. Cerebrospinal fluid (CSF) ferritin has been proposed to be highly specific and sensitive to detect hemorrhagic central nervous system (CNS) disease. We analyzed here the specificity of CSF ferritin in a large series of various CNS diseases and the influence of serum ferritin.Materials and methodsCSF ferritin, lactate, protein and total cell count were analyzed in 141 samples: neoplastic meningitis (n = 62), subarachnoid hemorrhage (n = 20), pyogenic infection (n = 10), viral infection (n = 10), multiple sclerosis (n = 10), borreliosis (n = 5) and normal controls (n = 24). Cerebrospinal fluid ferritin was measured with a microparticle immunoassay. In addition, serum and CSF ferritin were compared in 18 samples of bacterial and neoplastic meningitis.ResultsIn CNS hemorrhage, median ferritin was 51.55 μg/L (sensitivity: 90%) after the second lumbar puncture. In neoplastic meningitis, the median CSF ferritin was 16.3 μg/L (sensitivity: 45%). Interestingly, ferritin was higher in solid tumors than that in hematological neoplasms. In 90% of pyogenic inflammation, ferritin was elevated with a median of 53.35 μg/L, while only 50% of patients with viral infection had elevated CSF ferritin. In ventricular CSF, median ferritin was 163 μg/L, but only 20.6 μg/L in lumbar CSF. Ferritin was normal in multiple sclerosis and borreliosis.ConclusionsFerritin was elevated not only in hemorrhagic disease, but also in neoplastic and infectious meningitis. Ferritin was not a reliable marker of the course of disease. The influence of serum ferritin on CSF ferritin is negligible. We conclude that elevated CSF ferritin reliably, but unspecifically indicates severe CNS disease.     

Etiological differences between the isolated lateral ventricle and the isolated fourth ventricle

Objective To determine if an etiological difference exists between isolation of the lateral ventricle and isolation of the fourth ventricle after ventricular shunting.Methods Cases of symptomatic isolation of the lateral and fourth ventricles were reviewed retrospectively. The ages at presentation of ventricular isolation, the time course to development of isolation, the number of shunt surgeries leading up to symptomatic isolation, the types of shunt valves utilized, and the background of infection were analyzed.Results Twenty-six patients had lateral ventricle isolation and 11 patients had fourth ventricle isolation. Infection, hemorrhage, Chiari malformation/myelomeningocele, and aqueductal stenosis were factors contributing to hydrocephalus requiring treatment in these patients. Compared to 26.9% of patients with lateral ventricle isolation, 90.9% of patients with fourth ventricle isolation had a previous history of infection.Conclusions Prior meningitis and ventriculitis frequently contributed to fourth ventricle isolation. Lateral ventricle isolation seems to arise from functional obstruction of the foramen of Monro related to prior shunting.     

Intracranial Microbial Aneurysm (Infectious Aneurysm): Current Options for Diagnosis and Management

The histopathological characteristic of intracranial microbial aneurysm (MA)—infectious aneurysm is the presence of infection and destruction of the walls of the vessels. It can occur in the setting of predisposing infections that spread by endovascular mechanism (e.g., infective endocarditis) or extravascular mechanism (e.g., meningitis). MA is probably a better term than mycotic, infectious, or infective aneurysm as a wide variety of bacteria, fungi, mycobacteria, and virus can cause MA. Typically MAs are multiple, distal, and fusiform aneurysms, but the angiographic and clinical presentations can vary widely. The most common presentation of MA is intracranial bleed. CT angiography, MR angiography, or Digital subtraction angiography can be deployed to detect MA. By combining the clinical findings, imaging, and angiographic findings, it is possible to arrive at a correct diagnosis in most instances. MAs carry higher risk of rupture and fatal bleed when compared to other aneurysms. The treatment options include antimicrobial therapy, surgery, and endovascular therapy. The management strategy is based on large case series rather than controlled trials. All MA should receive appropriate antibiotic therapy. Ruptured MA with mass effect would require surgery in most situations, while those without mass effect and in non-eloquent locations could also be managed by endovascular therapy. Unruptured MA could be managed according to the size, location, and risk of bleeding—by antibiotic therapy, surgery, or endovascular therapy. Monitoring the resolution of the MA under antibiotic therapy by serial CT angiography is another option, but it carries higher risk of bleeding. Treatment of the underlying predisposing infection is an important component of therapy.     

脑膜炎大肠杆菌侵袭素ibeA蛋白在大肠杆菌中的表达和纯化

目的:为了研究大肠杆菌ibeA的有效表达方法。方法:通过PCR扩增得到大量ibeA基因,并将扩增后的ibeA蛋白基因插入pGEX载体,转化E.coliDH5α,得到ibeADNA重组子的克隆。并以包涵体和可溶形式获得大量表达。结果:亲和层析纯化后获得了大量纯化蛋白,所获得的ibeA蛋白具有良好的抗原性。结论:该方法为进一步研究ibeA介导E.coli穿入血脑屏障的机理,以及筛选ibeA侵袭素的拮抗剂奠定了基础。     

脑脊液酶谱对小儿不典型细菌性脑膜炎诊断意义的临床研究

目的探讨脑脊液酶谱的变化对小儿不典型细菌性脑膜炎的诊断意义。方法根据脑脊液(CSF)细菌学检查和病毒特异性IgM抗体测定的结果,将126例脑膜炎患者分为小儿不典型细菌性脑膜炎组和病毒性脑膜炎组,分别对其CSF进行酶谱检测。同时,选取30例正常脑脊液作为对照。结果小儿不典型细菌性脑膜炎组患者CSF中AST、ALT、γ～GT、ALP、LDH、CK～BB、NSE的含量显著高于病毒性脑膜炎组和正常对照组,组间差异有极显著意义(P<0.01)。结论小儿不典型细菌性脑膜炎患者CSF的酶谱呈相对特异性的变化,有助于临床对细菌性脑膜炎的诊断和鉴别诊断。