新生儿和小婴儿化脓性脑膜炎的临床特征和致病菌特点

Characteristics of clinical and pathogenic bacteria of purulent meningitis in newborn and infants

目的:探讨新生儿和小婴儿(≤3月龄)化脓性脑膜炎的临床特征和致病菌特点。方法:抽取广州市妇女儿童医疗中心2016年1月至2018年12月收治的临床诊断为化脓性脑膜炎的新生儿和小婴儿作为研究对象,统计分析新生儿组和小婴儿组患儿临床表现、辅助检查、致病菌之间的差异。结果:59例患儿纳入分析,新生儿组34例,小婴儿组25例。两组非特异性表现(发热、呼吸道症状、消化道症状)、神经系统主要表现(抽搐、反应差、呕吐、肢体瘫痪)、脑脊液常规和生化指标比较差异未见统计学意义(P>0.05);两组血、脑脊液细菌培养阳性例数比较差异未见统计学意义(P>0.05);新生儿组无乳链球菌的感染率(26.5%,9/34)高于小婴儿组(4.0%,1/25),χ2=5.168,P=0.023,。结论:新生儿和小婴儿化脓性脑膜炎临床表现不典型,有重症呼吸道感染或抽搐者,伴有外周血C-反应蛋白明显升高,宜早期行腰椎穿刺检查。无乳链球菌对新生儿危害大,应加强预防。

Objective To investigate the clinical characteristics and pathogenic bacteria characteristics of purulent meningitis in newborn and infants(less than or egual to 3 months old).Methods Newborns and infants diagnosed as suppurative meningitis admitted to Guangzhou Women and Children’s Medical Center from January 2016 to December 2018 were selected as the study objects.The differences in clinical performance,auxiliary examination and pathogenic bacteria between newborn group and small infant group were analyzed.Results Fifty-nine cases were included in the analysis,34 cases in the newborn group and 25 cases in the small infant group(less than or equal to 3 months old).There were no significant differences in the incidences of nonspecific manifestations(fever,respiratory symptoms,digestive tract symptoms),main manifestations of nervous system(convulsions,poor response,vomiting,limb paralysis),cerebrospinal fluid routine and biochemical indicators between the two groups(P>0.05).There were no significant differences in the number of positive bacterial cultures in blood and cerebrospinal fluid between the two groups(P>0.05).The infection rate ofStreptococcus agalactiae in neborn group was 26.5%(9/34),which was higher than the 4.0%(1/25)in small infant group(χ2=5.168,P=0.023).Conclusions Theclinical manifestations of purulent meningitis in newborns and infants are not typical,in patients with severe respiratory tract infection or convulsion,C-reactive protein in peripheral blood increases significantly,lumbar puncture should be done early.Streptococcus agalactiae is harmful to newborns,so we should strengthen the prevention.