成人不典型细菌性脑膜炎16例临床分析

Clinical analysis of 16 cases with adult atypical bacterial meningitis

目的探讨成人不典型细菌性脑膜炎的临床表现、治疗和预后。方法回顾性分析我院16例成人细菌性脑膜炎患者的临床资料。结果 16例患者中仅有1例患者出现了典型的脑膜炎三联征,所有患者的脑脊液理化性状均不符合典型细菌性脑膜炎改变。16例患者均经脑脊液培养确诊为细菌性脑膜炎:表皮葡萄球菌感染5例(31.25%),肺炎链球菌感染4例(25%),单核李斯特菌感染4例(25%),大肠杆菌感染2例(12.5%),金黄色葡萄球菌感染1例(6.25%)。经抗生素联合短期激素治疗,14例痊愈,2例死亡。结论临床表现不典型的成人细菌性脑膜炎容易误诊,必须早期行脑脊液培养及药敏试验进行诊断。患者预后不佳的原因可能与耐药菌感染、高龄、早期意识障碍和血培养阳性有关。

Objective To study the clinical characteristics of cases with adults bacterial meningitis. Methods Clinical data of 16 cases with adult bacterial meningitis were retrospectively analyzed. Results Only one case showed typical meningitis triad syn- drome,while cerebrospinal fluid physicochemical properties of other 15 cases were inconformity with typical bacterial meningitis change. All cases were diagnosed as bacterial meningitis by cerebrospinal fluid culture. In these cases ,5 cases （31.25 % ）were infected by Staphylococcus epidermidis,4 cases（25% ）by Streptococcus pneumoniae, 4 cases （25%）by Single kernel Lester bacteria, 2 cases （ 12. 5% ）by escherichia coli, and 1 case（6. 25 % ）by staphylococcus aureus. After treatment with combination of antibiotics with short- term of hormone, 14 cases were cured and 2 cases died. Conclusion Adults with atypical bacterial meningitis are easy to be misdiag- nosed. Thus, cerebrospinal fluid culture and drug sensitivity test must be done as early as possible. The risk factors of unfavorable out- come are infections with drug resistance bacteria, advanced age, early impairment of consciousness, and positive results of blood cultiva- tion.