早产儿真菌性脑膜炎的临床及随访分析

Clinical features and follow-up of fungal meningitis in preterm infants

目的 分析早产儿真菌性脑膜炎的临床特点及随访情况,为合理诊治及随访提供依据.方法 选择2008年9月至2012年8月我院早产新生儿病房收治的真菌性脑膜炎早产儿临床资料进行回顾性分析,总结患儿一般资料、临床表现、辅助检查、治疗、转归和随访情况.结果 研究期间共收治7例真菌性脑膜炎早产儿,患儿胎龄均＜32周,其中极低出生体重儿4例.7例患儿感染前全部应用胃肠外营养,接受了三代以上头孢类抗生素治疗.诊断日龄9 ～ 30天,表现为呼吸暂停、发热、惊厥、反应低下.6例有血常规改变,4例C反应蛋白明显升高,5例血培养为白色念珠菌,对氟康唑及两性霉素B均敏感,2例为白色念珠菌生物变种,仅对两性霉素B敏感,脑脊液检查均有白细胞数和总蛋白的增高,2例脑脊液培养阳性,5例患儿有明显颅内影像学改变.5例给予氟康唑治疗,2例给予两性霉素B治疗,疗程21～50天,5例治愈出院,1例好转出院,1例放弃治疗.治疗过程中未见严重药物不良反应.7例患儿除1例放弃治疗外,余均随访,4例患儿神经发育情况基本正常,头颅影像学正常;其余2例神经发育严重落后的患儿,均于起病2周左右头颅影像学证实形成了脑软化灶或液化区.结论 早产儿真菌性脑膜炎多见于胎龄＜32周的早产儿,以白色念珠菌感染多见,呼吸暂停为早期主要临床表现,可能与长期接受胃肠外营养和应用广谱抗生素等因素有关,头颅B超是经济有效的检查方法,颅内形成软化灶或液化区可能提示其预后不佳.

Objective To analyze clinical features and follow-up of fungal meningitis in preterm infants for better diagnosis,treatment and follow-up plans.Methods The clinical data of 7 premature infants admitted to NICU during September 2008 and Autumn 2012 with fungal meningitis were analyzed retrospectively.The data included general information,clinical manifestations,laboratory examinations,treatment,prognosis and follow-up.Results All infants＇ gestational age （GA） were 〈 32 weeks,including 4 cases of very-low-birth-weight infants（VLBWI）.All cases received parenteral nutrition and third generations of cephalosporin antibiotics before infection.The onset time were 9 to 30 days after birth,with apnea,fever,convulsions and poor response as clinical presentation.6 cases had abnormal complete blood count （CBC）,and 4 cases had elevated C-response protein （CRP）.5 cases had postitive blood culture.CSF examination showed elevated WBC and protein in all patients,two cases were positive in CSF culture.Brain imaging were abnormal in 5 cases.Fluconazole or amphotericin B were used for 21 to 50 days,5 cases were cured,one case improved,and one case aiven up.No serious adverse drug reaction occured.During follow-up 4 cases had normal neurodevelopment without identifiable leisions on brain imaging.2 cases had retarded neurodevelopment with liquefied or malacia loci on brain imaging in 2 weeks during follow-up.Conclusions Fungal meningitis is common in premature infants with GA 〈 32 weeks,with apnea the most common initial manifestation and Candida albicans the most common pathogen.Long-term parenteral nutrition and broad-spectrum antibiotics may be risk factors.Cranial ultrasound is a cost-effective way in diagnosis and follow-up.Liquefied or malacia loci in the brain may contribute to the poor prognosis of fungal meningitis in premature infants.