上海地区2006-2008年儿童流行性脑脊髓膜炎的临床特征

Clinical Features of Epidemic Cerebrospinal Meningitis of Children in Shanghai Area during 2006 to 2008

目的了解近2.5 a上海地区儿童流行性脑脊髓膜炎(流脑)的流行特征及临床特征。方法对2006年1月-2008年6月复旦大学附属儿科医院收治的27例流脑患儿的临床表现、流行病学、检验结果等资料作回顾性分析,并对明确分群的A、B、C 3群流脑病例的临床表现行统计学分析。结果近2.5 a上海地区儿童流脑主要呈散发流行,以每年2-4月份为流行高发季节,发病者以外来儿童居多(92.6%)。临床表现以普通型为主(占74.1%),暴发型占25.9%。14株脑膜炎球菌血清学分群和2例脑脊液脑膜炎球菌PCR分群结果为A群4例,B群4例,C群8例。A群流脑均无疫苗接种史,暴发型占25.0%,50.0%有皮肤淤点淤斑,皮肤坏死25.0%,50.0%有中枢并发症。B群流脑无暴发型,皮肤淤点淤斑少,且轻(仅1例),但极期抽搐多见(75.0%),均有中枢并发症,个别有后遗症。C群流脑62.5%已接种A群流脑疫苗,各年龄组均有发病,皮肤淤点淤斑占87.5%,皮肤坏死占50.0%,恢复期免疫性发热占75.0%,中枢并发症占12.5%。结论1.目前流脑在上海地区儿童中呈散发流行,以外来儿童发病为主。2.A群流脑临床表现典型,B群流脑易并发硬脑膜下积液和脑室膜炎,C群流脑多见,临床暴发型比例高,主要为休克型,恢复期免疫性发热多见。应重视C群脑膜炎球菌的预防接种。

Objective To investigate the epidemiology and clinical features of epidemic cerebrospinal meningitis of children in Shanghai area in the last 2.5 years. Methods A retrospective study was conducted in 27 hospitalized patients with epidemic cerebrospinal meningitis by analyzing the clinical manifestation, epidemiology and laboratory test fingdings from Jan. 2006 to Jun. 2008. Statistical analysis of the clini- cal manifestations of cases in serogroup A, B and C was performed according to Neisseria meningitidis infection. Results There were sporadic cases of children with epidemic cerebrospinal meningitis in Shanghai area in the last 2.5 years. The seasonal distribution illustrated the peak occurrence from Feb. to Apr. Among all these cases,92.6% were floating children. Common types （74.1% ） were the predominant clinical manifestations and the others were fulminate types （25.9%）. Four cases in each of serogroup A and B ,and 8 cases of serogroup C were iden- tified by serotyping on 14 Neisseria meningitidis strains and genotyping on the other 2 cases＇ cerebrospinal fluid specimens. All the patients in serogroup A with meningococeal diseases were not vaccinated before and 25.0% of them belonged to fulminate types. Half of the cases had petechia on the skin and the prevalence of skin necrosis was 25.0% and 50% had complications of nervous system. No fulminate type was present in cases of serogroup B meningococcal disease and only l ease had slight petechia on the skin. However, intensive convulsions oc- curred in 75.0% of the patients,and all of them had complication of nervous system,with a few had sequela. Among the patients in serogroup C meningococcal disease,62.5% patients were vaccinated with serogroap A Neisseria meningitidis. In serogroup C, Neisseria meningitidis in- fection was found in eaeh age group,with petechia on skin,skin necrosis,immunity correlation fever and complications of nervous system in 87.5% ,50.0% ,75.0% and 12.5% of the patients,respectively. Conclusions I. Epidemic cerebrospinal meningitis occurred sporadically in children in Shanghai area, the majority of patients were floating populations. 2. Clinical manifestation was typical in patients of serogroup A meningococcal disease. Subdural effusion or ventricalitis was more common in patients of serogroup B meningococcal disease. In serogroup C, Neisseria meningitidis was the most prevalent serotype leading to epidemic cerebrospinal meningitis. More eases were found in patients infected with serogroup C, Neisseria meningitidis with severe shock and immunity correlation fever compared with the other groups. Prophylactic vaccination of serogroup C polyvalent meningococcal organism should be recommended.