127例细菌性脑炎脑膜炎症候群流行病学分析

Epidemiological analysis of 127 of bacterial encephalitis and meningitis syndrome

目的分析濮阳市病原确诊的细菌性脑炎脑膜炎症候群病例的监测结果,了解濮阳市细菌性脑炎脑膜炎症候群病原菌流行特征。方法对3所哨点医院报告的病原确诊的细菌性脑炎脑膜炎症候群病例开展流行病学调查,采集脑脊液、血液和临床分离菌株,对脑脊液和血标本进行细菌培养,对病原菌进行鉴定。结果收集2010年~2018年濮阳市病原确诊的细菌性脑炎脑膜炎症候群病例127例,采集脑脊液和血液236份,检出病原菌157株。应用抗生素影响血和脑脊液中病原菌的检出(P<0.05)。濮阳市细菌性脑炎脑膜炎症候群病原谱依次为肺炎链球菌(32.28%)、单核细胞增生李斯特氏菌(11.81%)、凝固酶阴性的葡萄球菌(8.66%)、无乳链球菌(7.09%)、脑膜炎奈瑟氏菌(4.72%)、流感嗜血杆菌(4.72%)和微球菌(4.72%)。1岁以下的新生儿和婴儿是细菌性脑炎脑膜炎的主要发病人群(68.50%),并且病原菌构成复杂多样。新生儿细菌性脑炎脑膜炎病原谱依次是单核细胞增生李斯特氏菌(25.71%)、无乳链球菌(20.00%)和凝固酶阴性的葡萄球菌(11.43%)。1岁以内婴儿病原菌主要是肺炎链球菌(44.23%)和凝固酶阴性的葡萄球菌(9.62%)。1岁~3岁幼儿以肺炎链球菌(36.84%)、脑膜炎奈瑟氏菌(15.79%)和流感嗜血杆菌(15.79%)为主,3岁~20岁各年龄组均以肺炎链球菌(55.56%)和脑膜炎奈瑟氏菌(33.33%)为主,20岁以上的成年人和老年组则以单核细胞增生李斯特氏菌(41.67%)和肺炎链球菌(33.33%)为主。肺炎链球菌是各个季节的主要病原,季节性不明显。单核细胞增生李斯特氏菌主要发生在春夏秋季,无乳链球菌发生于春秋冬季,凝固酶阴性的葡萄球菌主要发生在春夏冬季。脑膜炎奈瑟氏菌在冬春季节流行,流感嗜血杆菌好发于春秋季。结论濮阳市细菌性脑炎脑膜炎症候群病原菌分布存在季节、地区、人群年龄差异。近几年,病原谱演变成以肺炎链球菌、单核细胞增生李斯特氏菌、无乳链球菌、脑膜炎奈瑟氏菌和流感嗜血杆菌为濮阳市细菌性脑炎脑膜炎症候群的优势流行菌株。

Objective To understand epidemiological characteristics of pathogenic bacteria in pathogen confirmed cases of bacterial encephalitis and meningitis syndrome in Puyang by surveillance analysis.Methods Epidemiological investigation of pathogen confirmed cases of bacterial encephalitis and meningitis syndrome reported in three sentinel hospitals was conducted from 2010 to 2018.The serum and the cerebrospinal fluid specimens were collected for traditional isolation and cultured identification.Meanwhile,the strains detected clinically were collected for identification.Results A total of 127 pathogen confirmed cases of bacterial encephalitis and meningitis syndrome in Puyang from 2010 to 2018 were collected,236 cases of cerebrospinal fluid and blood were collected,and 157 strains of pathogenic bacteria were detected.The use of antibiotics affected the detection rate of pathogens in blood and cerebrospinal fluid(P<0.05).The pathogen spectrum of bacterial encephalitis and meningitis syndrome in Puyang were Streptococcus pneumoniae(32.28%),Listeria monocytogenes(11.81%),coagulase-negative staphylococcus(8.66%),Streptococcus agalactiae(7.09%),Neisseria meningitidis(4.72%),Haemophilus influenzae(4.72%)and micrococcus(4.72%).The neonates and the infants under 1 year old were the main pathogenic population of bacterial encephalitis and meningitis(68.5%),and the pathogenic bacteria were complex and varied.The pathogen spectrum of the neonates were Listeria monocytogenes(25.71%),Streptococcus agalactiae(20.00%)and coagulase-negative staphylococcus(11.43%).The main pathogenic bacteria of infants within 1 year old were Streptococcus pneumoniae(44.23%)and coagulase-negative staphylococcus(9.62%).The main pathogen spectrum of the children aged 1 to 3 years old were Streptococcus pneumoniae(36.84%),Neisseria meningitidis(15.79%)and Haemophilus influenzae(15.79%).The Streptococcus pneumoniae(55.56%)and the Neisseria meningitidis(33.33%)were dominant in all age groups from 3 to 20 years old.The pathogenic bacteria of the adults over 20 years old and the elderly group were dominated by Listeria monocytogenes(41.67%)and Streptococcus pneumoniae(33.33%).The Streptococcus pneumoniae was the main pathogen in all seasons,and Seasonality was not obvious.The Listeria monocytogenes mainly occurred in spring,summer and autumn,The Streptococcus agalactiae mainly occurred in in spring,autumn and winter.The coagulase-negative staphylococcus mainly occurred in spring,summer and winter.The Neisseria meningitidis prevailed in winter and spring.The Haemophilus influenzae mainly occurred in spring and autumn.Conclusions The pathogen distribution of bacterial encephalitis meningitis syndrome in puyang city was different in season,region and age.In recent years,Streptococcus pneumoniae,Listeria monocytogenes,Streptococcus agalactis,Neisseria meningitidis and Haemophilus influenzae were the dominant strains in the pathogen spectrum of bacterial encephalitis and meningitis in puyang.