小儿流行性腮腺炎并发脑膜脑炎71例临床分析

小儿流行性腮腺炎并发脑膜脑炎７１例临床分析刘惠莲谭红＊罗祥英叶强华华西医大附属第二医院儿科流行性腮腺炎并发脑膜脑炎（以下简称腮脑），是流行性腮腺炎（以下简称流腮）最常见的并发症。本文总结了我院一九八九年八月至一九九四年十一月收治的腮脑患儿７１例，现报...

50例流行性腮腺炎并发脑膜脑炎临床观察

流行性腮腺炎是腮腺炎病毒引起的小儿常见的急性传染病之一,常并发脑膜脑炎(简称腮脑)。若及时诊断、治疗,预后良好,但也容易误诊,延误治疗。现将我院1976—1996年收治腮脑50例进行分析。现报告如下:

小儿病毒性脑炎和化脓性脑膜炎脑脊液铁蛋白测定及其意义

脑脊液铁蛋白测定国内研究较少,为了解颅内感染时脑脊液铁蛋白的变化,我们对病毒性脑炎(病毒脑)、化脓性脑膜炎(化脑)脑脊液铁蛋白进行了测定,现报告如下。 资料与结果 一、对象 对照组22例,男13例,女9例;年龄6个月～12岁;原发病为上感、低血钙、肺炎,因高热抽搐或神萎而作腰椎穿刺,脑脊液检查均正常,

一起流行性脑脊髓膜炎流行病学调查

目的分析2005年乌鲁木齐市局部区域发生流行性脑脊髓炎(流脑)情况,评价采取的措施及控制效果。方法收集乌鲁木齐市近年流脑疫情资料,并采用现场调查法抽查近3年目标人群疫苗接种及对相关信息认知情况;根据疫情状况及流脑病原鉴定,采用相应的应对措施。结果2005年1～7月乌鲁木齐市报告流脑病例76例,其中实验室确诊病例3例。病例以3～4月为多,主要在乌鲁木齐市天山区,73.68%来自流动人口,72.36%在15岁以下,近2～3年没有明确流脑疫苗接种史。所调查流动人群对流脑认知水平低,98%近3年未接种过流脑疫苗。2003年乌鲁木齐市15岁以下在校中小学生接种过A+C流脑疫苗。优势菌株为A群脑膜炎奈瑟菌(Nm)。结论由于流动人口疏于管理,目标人群对流脑认知水平、自我保护意识和能力低下,流脑疫苗接种率极低,易感人群累积所致流脑流行。为此,对目标人群流脑疫苗采取了应急接种和预防性服药等措施控制了疫情扩散。

细菌性脑膜炎的治疗

此文为美国传染病委员会的报告。其目的在于估价新头孢菌素类制剂的疗效,并为确定婴儿和儿童细菌性脑膜炎初期治疗的最佳方案提供依据。为了更全面的讨论关于脑膜炎的诊断和处理,读者可参考美国儿科学会指定课题组最近发表的一篇报告。本文则超出该报告,提出以新的头孢菌素类作为第一线治疗药物,并对某些脑膜炎患者推荐更短期的疗程。本文也将发表论述促使病人更快出院、减少医疗费用的代替治疗方案,以及脑膜炎病人在家庭治疗处理的问题。

肉鸡发生的肠炎沙门氏菌病

发病鸡群从进雏之日起开始死亡,2—3周龄达到高峰,死亡率为15％。病理学检查可见败血型和化脓性髓膜脑炎型。细菌学检查,从主要脏器及大脑分离出肠炎沙门氏菌,血清学检查,11只中有8只为鸡白痢,出笼时部分材料肠炎沙门氏菌呈阳性。分离菌株对氨苄青霉素。

Listeria monocytogenes following orthotopic liver transplantation:Central nervous system involvement and review of the literature

Listeria monocytogene is a well-recognized cause of bacteremia in immunocompromised individuals, including solid organ transplant recipients, but has been rarely reported following orthotopic liver transplantation. We describe a case of listeria meningitis that occurred within a week after liver transplantation. The patient developed a severe headache that mimicked tacrolimus encephalopathy, and was subsequently diagnosed with listeria meningitis by cerebrospinal fluid culture. The infection was successfully treated with three-week course of intravenous arnpicillin. Recurrent hepatitis C followed and was successfully treated with interferon alfa and ribavirin. Fourteen cases of listeriosis after orthotopic liver transplantation have been reported in the English literature. Most reported cases were successfully treated with intravenous ampicillin. There were four cases of listeria meningitis, and the mortality of them was 50%. Early detection and treatment of listeria meningitis are the key to obtaining a better prognosis.

Epidemiological and pathogenic study on the outbreak of toxic shock syndrome and meningocephalitis caused by swine streptococcus

Objective: To reveal the relationship between the biological characteristics of pathogen and the pig to human spread of the epidemic and infectious disease in 1998 in East China. Methods: Epidemiological survey, pathological examination of pigs and patients, and pathogen isolation were performed. Results: The disease had a character of quick onset, serious symptoms, short course and high mortality. The clinical manifestations and pathological changes of the disease were high fever, sometimes with nausea, vomiting and diarrhea, then might develop to myositis, fascitis, DIC, multiple organ failure, shock and usually died in 2 3 d. Among 25 patients, 16 manifested clinically as streptococcal toxic shock syndromes and 9 streptococcal meningiocephalitis syndrome. The mortality was 81 25% and 11 11% respectively. Pathogenic bacteria isolated from diseased pigs and patients were found to have some common characteristics in morphology, staining and biological characters. Conclusion: The pathogen isolated from the blood of patients and pigs were identified as streptococci.

Inflammatory Myofibroblastic Tumor Mimicking Malignant Meningioma in the Middle Cranial Fossa:a Case Report

INFLAMMATORY myofibroblastic tumor（IMT）,alsoknown as inflammatory pseudotumor or plasma cellgranulomas,is an uncommon fibro-inflammatorylesion which is composed of inflammatory cells andmyofibroblastic spindle cells.1Its pathogenesis is still un-known.The tumor commonly occurs in the lung,upperrespiratory tract,live,orbit,abdominal membrane,retro-peritoneum,and genitourinary tract.2-4It rarely involvesthe central nerve system,5,

Phylogeny and Histopathology of Streptococcus iniae from Indonesia

Streptococcus iniae has been detected in several regions in Indonesia, such as Bali, Jambi and Papua. Outbreak of meningoencephalitis and septicemia was still often found in Papua. The aim of study was to compare phenotype, genotype and histopathology of S. iniae from Papua. Bacteria was identified using morphological and biochemical tests. It was also extracted, amplified and sequenced to see genotypic characters. The primer used were 5＇-AGAGTTTGATCCTGGCT-3＇ （24F） and 5＇-AAGGGAGGTGATCCAGCCGCA-3＇ （1540R） in 16S rRNA region. Result of sequencing was analyzed by the neighbor joining and maximum parsimony methods. The identification result of isolate from Papua was S. iniae. The amplification result was a sharp band--l,500 bp band in 16S rRNA region. The phylogenetic tree showed that isolate from Papua was closely related to S. iniae strains CMS005 from Guangxi China. Bacterial clumps of S. iniae was firstly found in the blood vessel of liver at the 3rd day after infection and then caused the inflammation to spleen, heart, brain, kidney and gut at the 7th day post infection.

Cytophagic Histiocytic Panniculitis with Encephaloclastic Changes:A Case Report and Literature Review

Cytophagic histiocytic panniculitis （CHP） was first described by Winkelmann and Bowie in 1980.vj It is a rare group of diverse illnesses involving benign and malignant proliferation of macrophages in various organs and tissues. It presents with subcutaneous panniculitis with or without a hemophagocytic syndrome （HPS）. It occurs predominantly in women （male： female ratio 1：1.3） between the years of 5-61 （average, 33.5）. The major clinical features are recurrent fever, multiple panniculitic lesions, anemia, leukopenia and coagulation abnormalities. In the later phase, liver dysfuction, serosal effusion, mucosal ulceration and hemorrhage may occur. Histological findings show activated histiocyte infiltration of the fat tissue. Cytologically the benign-looking histiocytes containing cell fragments （bean-bag cells） are very typical. CHP has a broad spectrum from mild to severe. Benign CHP is selflimiting and sensitive to treatment, but up to now there is no effective therapy for malignant CHP. We report here a case of progressive and fatal cytophagic histiocytic panniculitis in a young woman who had encephaloclastic changes immediately prior to her death.

Correlation of Cerebrospinal Fluid Sialic Acid with Various Enzymes in Patients with Meningitis

Meningitis is often associated with cerebral compromise which may be responsible for neurological squeal in nearly half of the survivors. Little is known about the mechanisms of Central Nervous System （CNS） involvement in bacterial meningitis. The present study was undertaken to assess the changes in biochemical parameters including glucose, protein, Sialic Acid （SA） and various enzymes like Aspartate Aminotransferase （AST）, Alanine Aminotransferase （ALT）, Creatine Kinase （CK）, Gamma Glutamyltranspeptidase 7 （GGTP） and Lactate Dehydrogenase （LDH） have been determined in the Cerebrospinal Fluid （CSF） of the meningitis patients （n = 26） and compared with control subjects （n = 26）. Total Protein, CK, SA （P 〈 0.02）, AST （P 〈 0.001） and ALT （P 〈 0.0001） of meningitis patients were significantly higher, whereas, glucose （P 〈 0.05） and Gamma Glutamyltranspeptidase （GGT） （P 〈 0.01 and P 〈 0.05, respectively） were significantly lower than those of the controls. This study suggests that loss of integrity of brain-CSF barriers, sialic acid and enzyme profiles may contribute to the severity and neurological complications of meningitis.

脑干听觉诱发电位早期诊断化脓性脑膜炎听力损害的评估

应用脑干听觉诱发电位（ＢＡＥＰ）对４０例化脓性脑膜炎患儿进行检测，其中３３例为＜２岁幼婴。结果表明，１５例ＢＡＥＰ异常，１０例显示周围性听路损害，３例脑干中枢性听路损害，２例混合损害。１０例随访１年，３例完全恢复，１例部分恢复，６例仍异常。提示ＢＡＥＰ对早期诊断新生儿、幼婴化脓性脑膜炎的听力损害、判断性质、预后的监测具有重要临床价值。

Clinical manifestations of AIDS with cryptococcal meningitis

Objective To increase the awareness of AIDS with cryptococcal meningitis.Methods Eighteen cases of confirmed AIDS with cryptococcal meningitis in the Bata Regional Hospital, Equatorial Guinea from January 1997 to November 1999 were analyzed. Results The clinical manifestations of the 18 cases were: insidious onset, fever, severe headache, generalized pain, nausea and vomiting, weight loss and dehydration, and enlarged cervical lymph nodes. Boa's and Cullen's signs were positive. The positive rates of cerebrospinal fluid (CSF) India ink stain and the polysaccharide capsule antigen (ELISA) were 77.8% and 99.4%, respectively. The positive rate of CSF culture of cryptococcus was 100%. The mortality rate was 83.3%.Conclusion Cryptococcal meningitis is the most common opportunistic infection and one of the major causes of deaths in AIDS patients. The misdiagnosis and mortality rates were very high and could be explained by a lack of awareness for the occurrence of AIDS with cryptococcal meningitis, late presentation, serious illness and severe complications, and delayed and inadequate therapy.

Cerebrospinal fluid otorrhea secondary to congenital inner ear dysplasia: diagnosis and management of 18 cases

Objective:To describe the characteristics of the clinical presentation,diagnosis,surgical methods,and outcomes of patients with otogenic cerebrospinal fluid(CSF)leakage secondary to congenital inner ear dysplasia.Methods:A retrospective review was performed of 18 patients with otogenic CSF leakage secondary to inner ear dysplasia who underwent surgery in our group from 2007 to 2017 and had a follow-up of at least 4 months.The average length of follow-up was three years.The characteristics of the clinical presentations of all patients,such as self-reported symptoms,radiographic findings,surgical approaches and methods of repair,position of the leakage during surgery,and postoperative course,including the success rate of surgery,are presented.Results:The patients presented mostly with typical symptoms of meningitis,severe hearing impairment,and CSF otorrhea or rhinorrhea.All 18 patients had at least one previous episode of meningitis accompanied by a severe hearing impairment.The preoperative audiograms of 17 patients showed profound sensorineural hearing loss,and one patient had conductive hearing loss.Twelve patients presented with an initial onset of otorrhea,and two had accompanying rhinorrhea.Six patients complained of rhinorrhea,two of whom were misdiagnosed with CSF rhinorrhea and underwent transnasal endoscopy at another hospital.High-resolution computed tomography(HRCT)images can reveal developments in the inner ear,such as expansion of a vestibular cyst,unclear structure of the semicircular canal or cochlea,or signs of effusion in the middle ear or mastoid,which strongly suggest the possibility of CSF otorrhea.The children in the study suffered more severe dysplasia than adults.All 18 patients had CSF leakage identified during surgery.The most common defect sites were in the stapes footplates(55.6%),and 38.9%of patients had a leak around the oval window.One patient had a return of CSF otorrhea during the postoperative period,which did not re-occur following a second repair.Conclusions:CSF otorrhea due to congenital inner ear dysplasia is more severe in children than in adults.The most common symptoms were meningitis,hearing impairment,and CSF otorrhea or rhinorrhea.HRCT has high diagnostic accuracy for this disease.The most common fistula site was around the oval window,including the stapes footplates and the annular ligament.

Population pharmacokinetics of vancomycin in Chinese elderly patients and its application for dose individualisation

In the present study, we aimed to develop a population pharmacokinetics(PPK) model of vancomycin(VCM) and propose the individualised dosage regimen for Chinese elderly patients. The data were collected prospectively from Chinese elderly patients receiving VCM therapy. Steady-state trough concentrations of VCM were determined using an enzyme-multiplied immunoassay. Patients’ sex, age, body weight, concomitant medications, infection type, and laboratory findings were recorded. The PPK model was developed using nonlinear mixed-effects model software. Moreover, we used Monte Carlo simulations to develop an initial dosage regimen targeting various VCM through concentration ranges based on the final model. We found that VCM clearance(CL) was significantly influenced by post-craniotomy meningitis(PCM) and glomerular filtration rate in elderly patients. Additionally, a new dosage regimen was proposed to individualise VCM regimen for PCM and non-PCM elderly patients. A PPK model was established to estimate the individual VCM CL for elderly patients, which could be applied for individualising doses in the target population.

A 61-year-old man with bloody purulent cerebrospinal fluid

Staphylococcus aureus meningitis(SAM)is a relatively uncommon but serious disease,accounting for only 1%–9%of cases of bacterial meningitis.In this report,we described a 61-year-old man,whose appearance of CSF was bloody and purulent.CSF test showed extremely elevated WBC count and protein quantification.Bacterial culture demonstrated SAM.Complications included septic shock,acute respiratory failure,and renal failure.Empiric antibiotic treatment was not effective for him.Therefore,we prescribed up to five types of antibiotics.We found that the clinical symptoms,CSF indicators,inflammatory markers,respiratory and renal function got better.The nerve function comparatively recovered well after 6 months of follow-up.

Analysis of anti-infection therapeutic schedule analysis for neonatal Streptococcus agalactiae meningitis and discussion on the indications for drug withdrawal

The clinical manifestations of neonatal GBS meningitis are as follows:non-specificity,long hospital stay,easy to cause neurological complications,and sequelae.Clinical pharmacist participated in the anti-infective treatment of a neonatal Streptococcus agalactiae meningitis whose cerebrospinal fluid was still abnormal when the drug was stopped.According to the PK/PD characteristics of antibacterial drugs,the permeability of the blood-brain barrier,and the adjustment of the antibiotic dose,the reasons for the decrease in the number of cerebrospinal fluid cells after vancomycin treatment were analyzed.Clinical pharmacists also analyzed the efficacy of linezolid in the treatment of neonatal bacterial meningitis,and discussed the indications for stopping medication when the cerebrospinal fluid is abnormal,so as to improve the safety and effectiveness of antibiotics in the treatment of neonatal bacterial meningitis.