湖北省宜昌市2016年急性脑炎与脑膜炎症候群监测分析

Acute meningitis,encephalitis syndrome surveillance of Yichang,Hubei in 2016

目的分析2016年宜昌市各类急性脑炎、脑膜炎的流行特征,了解其病原谱及临床诊断符合性情况,为该症候群的疾病防控工作提供科学依据。方法在湖北省宜昌市选取4家市级医院及2家县级医院作为监测哨点医院,进行急性脑炎和脑膜炎的病例监测,对监测病例进行流行病学调查以及血清和脑脊液标本的实验室检测。结果总共监测病例201例,监测病例以大于45岁患者居多,春夏两季报告病例较多,以农民居多,实验室通过IgM抗体检测确诊的病毒性脑炎病原构成中,前三位分别为流行性腮腺炎病毒(28.1%)、科萨奇病毒(28.1%)和单纯疱疹病毒(25.0%)。细菌性病原构成主要是肺炎链球菌(50.0%)和金黄色葡萄球菌(33.3%)。结合临床诊断结果以及相关实验室诊断信息,在实际的临床诊断过程中,急性脑炎/脑膜炎的病例误诊概率相对较高。结论春夏季应作为急性脑炎/脑膜炎防控的主要季节,高年龄组是脑炎脑膜炎需要高度关注的人群,开展早期病原学检测可以及时有效地诊断脑炎脑膜炎,同时可使该病症的治愈率提高,减少患者并发症。

Objective To analyze the epidemic characteristics of Yichang City in 2016 of acute encephalitis, meningitis, the pathogens and clinical diagnosis of the situation, to provide a scientific basis for the prevention and control of the disease syndrome. Methods A total of 4 municipal hospitals and 2 county-level hospitals in Yichang were selected as the sentinel hospitals for monitoring the cases of acute encephalitis and meningitis. Epidemiological investigation of the cases and laboratory detection of serum and cerebrospinal fluid samples were carried out. Results A total of 201 cases of monitoring, the majority of surveillance cases were the patients aged over 45 years old. Spring and summer were the high onset season of these diseases, mostly to farmers, the laboratory constructed by viral encephalitis confirmed detection of IgM antibody, the top three were mumps virus (28.1%), Coxsackie virus (28.1%), herpes simplex virus (25.0%). Bacterial pathogens were mainly Streptococcus pneumoniae (50.0%) and Staphylococcus aureus (33.3%). The clinical diagnosis of encephalitis or meningitis was misdiagnosed to a large extent by combining the results of clinical diagnosis with the results of laboratory diagnosis. Conclusion The spring and summer seasons should be regarded as the main period for the prevention and control of acute encephalitis meningitis, encephalitis in the high age group should be highly concerned.The early pathogen detection would be useful to timely diagnosis, and improve the cure rate and reduce complications of early encephalitis or meningitis.