儿童非结核分支杆菌脑膜炎误诊分析

Analysis about misdiagnosed children non-mycobacterium tuberculosis meningitis

非结核分支杆菌脑膜炎与结核分支杆菌脑膜炎的临床表现、射线胸片特征极为相似,仅靠胸片和痰菌抗酸染色涂片无法区分。临床上在未行抗酸杆菌菌型鉴定的情况下,即给予抗结核治疗是造成误诊的主要原因。儿童非结核分支杆菌脑膜炎病的临床特点:1)儿童患者可以发病;2)呼吸系统症状较轻,缺乏特异性,神经系统症状明显,且病情进展迅速,脑脊液生化似化脓性脑膜炎改变;3)脑脊液检查到NTM阳性;4)抗化脓菌治疗无效,抗痨治疗有效,但病情反复,易复发;5)经长期规律抗痨治疗可治愈。

It is impossible to distinguish the non-mycobacterium tuberculosis（ NMT） meningitis from the mycobacterium tuberculosis meningitis,because both of the calinical manifestation and the characteristic of Chest radiography about them are very similar. The primary cause of misdiagnosis is to anti-tuberculosis therapy without the identification about the type of acid-fast bacillus. Here,we analyzed the clinical data about misdiagnosed children non-mycobacterium tuberculosis meningitis,and concluded the clinical characteristic about it： 1） The disease could invade children. 2）The symptom about respiratory system is slight relatively and short of specificity. However,the symptom about the nervous system is more obvious and the pathogenetic condition progress quickly. The biochemical analysis of CSF is similar to that of purulent meningitis. 3） The NTM is found in CSF. 4） Anti-tuberculosis therapy is utility to the disease rather than anti-progenic bacteria therapy. However,the pathogenetic condition is subject to recurrent. 5） The disease can be cured after long-termed and regular anti-tuberculosis therapy.