儿童急性白血病合并细菌性脑膜炎7例临床分析

Clinical analysis of 7 children with acute leukemia complicated with bacterial meningitis and the review of literature

目的总结儿童急性白血病合并细菌性脑膜炎的临床特点、治疗情况及预后。方法回顾性分析2018年1月至2019年12月郑州大学第一附属医院儿童医院收治的7例急性白血病合并细菌性脑膜炎患儿的临床资料,总结分析其临床特点、治疗方法及预后。结果7例患儿中急性髓系白血病(AML)4例(非M 3)、急性淋巴细胞白血病(ALL)3例,2例发生于7月份、3例发生于8月份、2例发生于9月份。所有患儿均有高热、头痛,3例患儿有呕吐,1例脑膜刺激征阳性。其中4例患儿同时合并肺部感染。脑脊液细胞数(456~900)×10^(6)/L,均以中性粒细胞分类为主;脑脊液总蛋白684~2047 mg/L,5例患儿脑脊液糖含量减低,氯化物含量均正常;脑脊液培养阳性3例,缓症链球菌1例,肺炎克雷白杆菌2例。血培养阳性5例,其中口腔链球菌2例、缓症链球菌1例、肺炎克雷白杆菌2例。2例患儿头颅磁共振成像提示脑脓肿。4例患儿采取美罗培南联合万古霉素治疗,3例患儿单用美罗培南治疗,治疗疗程10~21 d,所有患儿均未遗留神经系统后遗症;4例AML患儿中2例因原发疾病复发,最终死亡,余2例持续缓解中;3例ALL患儿均持续缓解中。结论儿童急性白血病合并细菌性脑膜炎仍以发热、头痛、呕吐为主要临床表现,给予有效的抗生素治疗后预后良好,不影响原发疾病的结局。

Objective To study the clinical feature,treatment and prognosis in children acute leukemia complicated with bacterial meningitis.Methods The clinical features,treatments and prognosis of 7 children with acute leukemia complicated with bacterial meningitis were retrospectively analyzed.All of the data were obtained from Children’s Hospital,the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2019.Results Among the 7 children,4 children suffered from acute myeloid leukemia(AML,non-M 3)and 3 children suffered from acute lymphoblastic leukemia(ALL).2 children occurred in July,3 children occurred in August,and 2 children occurred in September.All of the 7 children had high fever and headache,3 children had vomiting,1 case had positive meningeal irritation.Four cases had concurrent pulmonary infection.The number of cerebrospinal fluid cells was(456-900)×10^(6)/L,mainly classified by neutrophils;total cerebrospinal fluid protein was 684-2047 mg/L,decreased sugar in cerebrospinal fluid was found in 5 children.The results of microbiology check in cerebrospinal fluid were that 1 case was proved streptococcus mitis infection,and 2 klebsiella pneumonia infection.The results of microbiology check in blood were that 2 children were proved oral streptococcus infection,1 case streptococcus mitis infection,and 2 children klebsiella pneumonia infection.Cranial magnetic resonance imaging were done in all the 7 children,2 children showed abscess.Four cases were treated with meropenem combined with vancomycin,and 3 children were treated with meropenem alone.The course of treatment was 10 days to 21 days.All the 7 children had no neurological sequelae.Of the 4 children with AML,2 children eventually died due to the recurrence of the primary disease,and the remaining 2 children were continuous remission.Three cases of ALL were continuous remission.Conclusion Fever,headache and vomiting are still the main clinical manifestations in children acute leukemia complicated with bacterial meningitis.Effective antibiotic treatment has a good prognosis and does not affect the outcome of the primary disease.