Numerical Analysis of Bacterial Meningitis Stochastic Delayed Epidemic Model through Computational Methods

Based on theWorld Health Organization(WHO),Meningitis is a severe infection of the meninges,the membranes covering the brain and spinal cord.It is a devastating disease and remains a significant public health challenge.This study investigates a bacterial meningitis model through deterministic and stochastic versions.Four-compartment population dynamics explain the concept,particularly the susceptible population,carrier,infected,and recovered.The model predicts the nonnegative equilibrium points and reproduction number,i.e.,the Meningitis-Free Equilibrium(MFE),and Meningitis-Existing Equilibrium(MEE).For the stochastic version of the existing deterministicmodel,the twomethodologies studied are transition probabilities and non-parametric perturbations.Also,positivity,boundedness,extinction,and disease persistence are studiedrigorouslywiththe helpofwell-known theorems.Standard and nonstandard techniques such as EulerMaruyama,stochastic Euler,stochastic Runge Kutta,and stochastic nonstandard finite difference in the sense of delay have been presented for computational analysis of the stochastic model.Unfortunately,standard methods fail to restore the biological properties of the model,so the stochastic nonstandard finite difference approximation is offered as an efficient,low-cost,and independent of time step size.In addition,the convergence,local,and global stability around the equilibria of the nonstandard computational method is studied by assuming the perturbation effect is zero.The simulations and comparison of the methods are presented to support the theoretical results and for the best visualization of results.

Infantile bacterial meningitis combined with sepsis caused by Streptococcus gallolyticus subspecies pasteurianus:A case report

BACKGROUND Streptococcus gallolyticus subspecies pasteurianus(SGSP)is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings.Hence,we present a case of SGSP-induced infant meningitis and sepsis,accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus(MRSA),providing insights into the identification,management,and prognosis of this bacterial infection.CASE SUMMARY A 45-day-old female infant presented with two episodes of high fever(maximum temperature:39.5°C)and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms.Postadmission,the patient’s C-reactive protein level was 40.73 mg/L,white blood cell count was 13.42×10^(9)/L,neutrophil ratio was 78.4%,procalcitonin level was 7.89μg/L,cerebrospinal fluid(CSF)white cell count was 36×10^(6)/L,multinucleated cell ratio was 95.2%,and protein concentration was 0.41 g/L.Blood and CSF culture revealed that the pathogen was SGSP.The bacterium was sensitive to ampicillin,furazolidone,penicillin,lincomycin,moxifloxacin,rifampicin,vancomycin,and levofloxacin but resistant to clindamycin and tetracycline.Sputum culture revealed the presence of MRSA,which was sensitive to vancomycin.The patient was diagnosed with meningitis and sepsis caused by SGSP,accompanied by bronchopneumonia induced by MRSA.Ceftriaxone(100 mg/kg/d)combined with vancomycin(10 mg/kg/dose,q6h)was given as an anti-infective treatment postadmission.After 12 days of treatment,the infant was discharged from the hospital with normal CSF,blood culture,and routine blood test results,and no complications,such as subdural effusion,were observed on cranial computed tomography.No growth retardation or neurological sequelae occurred during follow-up.CONCLUSION SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures,and a sensitive antibiotic therapy to ensure a favorable prognosis.

Bacterial Meningitis Following Spinal Anesthesia for Caesarean Section

Bacterial meningitis has a potentially devastating outcome if there is any delay in diagnosis and treatment. There are multiple routes at which bacteria could migrate into the subarachnoid space. Lumbar puncture bypasses the natural defense barrier of central nervous system and therefore carries a risk of transmitting infection to the meninges. We report a case of post spinal bacterial meningitis in a post partum lady who underwent spinal anaesthesia for emergency lower segment caesarean section. She developed signs and symptoms of meningitis twenty-eight hours post procedure. Her cerebrospinal fluid (CSF) analysis was suggestive of bacterial meningitis and she made a full recovery.

Clinical Presentation and Outcome of Bacterial Meningitis in University Hospital

Purpose: To determine the clinical characteristics and outcome of bacterial meningitis in adult patients using CT, MRI and CSF culture. Methods: Patients admitted to the university hospital with clinical diagnosis of meningitis were included in the present study. All patients were subjected to clinical examination as well as CT, MRI scanning and CSF-bacteriological culture. Results: The age distribution of the patients shows that there is high frequency of symptoms found in the age group between ages 40 - 45. CSF in the present study included WBS, RBC, glucose and protein, which is associated with the adverse outcome. Meningitis can be confirmed by many methods, in the present study three different methods were used, which included CT scan, MRI and CSF analysis and bacterial culture. In CT scan, among the predictors of meningitis, persons with TB (P = 0.037), patients with HIV (P = 0.036) and stroke (P = 0.036) showed significant association. Whereas MRI findings were significantly associated with TB meningitis (P = 0.015). Meningitis was prevalent in the age group of <45. Conclusion: This study highlights the importance of several modalities for diagnosing and predicting the outcome of meningitis in adults.

Bacterial Meningitis of Infants and Children under Five Years Old in Brazzaville-Congo

Objective: to determine the epidemiological characteristics and outcomes of bacterial meningitis of infants and the children in Brazzaville after the introduction of Haemophilus influenzae type b and Pneumococcal vaccines. Patients and Methods: files of children aged from 1 to 59 months, hospitalized for bacterial meningitis between January, 2004 and December, 2013 in the Paediatric Intensive Care Unit of the Teaching Hospital of Brazzaville were reviewed. Studied variables included: age, gender, place of residence, immunization status, motive of hospitalization, laboratory analysis of the cerebrospinal fluid, and the outcome. Results: Overall 219 cases were included out of 22,148 admitted children, thus a frequency of 0.99%. Of the 219 children, 144 (65.8%) did not receive any dose of the Haemophilus influenzae b vaccine, 15 (6.8%) were incompletely vaccinated, and 60 (2.4%) were up-to-date. Concerning the Pneumococcal vaccine, 213 (97.2%) were not vaccinated, three (1.4%) were incompletely vaccinated, and the other three (1.4%) were up-to-date. Meningitis was severe in 139 cases (63.3%). The main isolated germs were: the Streptococcus pneumoniae with 46 cases (41.0%), and Haemophilus influenzae b with 16 cases (14.3%). Ninety-five children (43.4%) died in the course of the disease. The mortality rate was 7.1% before the introduction of the Haemophilus influenzae b vaccine, and 9.9% after its introduction, 8.5% after the introduction of the Pneumococcal vaccine. The lethality was 37% before and 45.1% after the introduction of the Haemophilus influenzae b vaccine and 52.8% after the introduction of the Pneumococcal vaccine. Conclusions: The high frequency and mortality rate due to meningitis necessitates the strengthening of the Expanded Program on Immunization.

Epidemiological, Clinical, Bacteriological and Evolutionary Profiles of Bacterial Meningitis in Children in Bangui (CAR)

Background: Bacterial meningitis is a major public health problem worldwide due to its severity. It is a vaccine-preventable disease. Methodology: It was a retrospective descriptive study conducted at the Pediatric Teaching Hospital of Bangui from June 2019 to May 2021. Children aged 1 month to 15 years hospitalized for bacterial meningitis were included in the study. Data were entered and analyzed using Stata/IC version 16.1. Results: Of 2490 patients hospitalized during the study period, 122 (4.9%) had bacterial meningitis. The patients were male in 54.92% of cases with a sex ratio of 1.21. The mean age was 35.95 months ± 49.16. Most of the patients (84.42%) came directly from home. The average consultation delay was 3.4 days ± 2.6. The vaccination coverage was 56.55%. The CSF study isolated germs from 24 patients (19.67%), the main ones being S. pneumoniae (75%) and H. influenzae (16.67%). Ceftriaxone was prescribed alone or in combination in all cases as first-line treatment. The average duration of antibiotic therapy was 8.95 days. The mortality rate was 27.87% and 12.30 % of patients had sequelae. Conclusion: Bacterial meningitis is common in Bangui and still poses a public health problem despite the introduction of new vaccines in the EPI. Improving vaccination coverage and raising awareness for early consultation could improve the situation.

Cerebrospinal fluid analysis,predictors of bacterial meningitis:a study in 312 patients with suspected meningial infection

Objective:Patients with cerebrospinal fluid(CSF)pleocytosis are routinely admitted to the hospital and treated with parenteral antibiotics,although few have bacterial meningitis(BM).The aim of this study was to evaluate predictors to differentiate BM from aseptic meningitis(ASM).Methods:The study was conducted in Razi hospital,a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran.and all patients were 18 years old or above and were treated in the hospital between 2003 and 2007.Data of those who had meningitis,tested as CSF pleocytosis but had not received antibiotic treatment before lumbar puncture were retrospectively analyzed.Results:Among 312 patients with CSF pleocytosis,two hundred fifteen(68.9%)had BM and ninety seven(31.1%)had ASM.The mean age for patients with BM was(34.7±17.7)years(P=0.22,NS).Sixty percent of the BM cases and 61.2% of the ASM cases occurred in men(P=0.70,NS).We identified the following predictors of BM:CSF-WBC count>100 per micro liter,CSF-glucose level<40 mg/dL,CSF-protein level>80 mg/dL.Sensitivity,specificity,PPV,NPV of these predictors,and LR for BM are 86.5%,52.6%,80.2%,63.7% and 104.1 for CSF-WBC count and 72.1%,83.5%,90.6%,57.4% and 164.2% for CSF glucose,and 49.7%,91.8%,93.4%,45.2% and 104.5% for CSF protein.Conclusion:The CSF WBC count should not be used alone to rule out bacterial meningitis.When it is combined with other factors such as CSF glucose and protein improved decision making in patients with suspected BM may occur.

Role of lumbar puncture in clinical outcome of suspected acute bacterial meningitis

BACKGROUND Meningitis remains a significant source of mortality and morbidity,with an incidence of 1 per 100000 persons in the United States.Guidelines recommend obtaining blood cultures and cerebrospinal fluid(CSF)studies in patients presenting with acute meningitis syndrome,and beginning treatment with broad spectrum antibiotics based on the age and certain predisposing conditions.In some patients however,the diagnostic lumbar puncture(LP)is not performed due to a multitude of reasons,ranging from increased intracranial pressure to failed attempt.In such situations,appropriate therapy is initiated empirically and often continued without establishment of a definitive diagnosis.AIM To determine whether a diagnostic LP in acute meningitis syndrome was associated with a better outcome and less duration of antibiotic therapy,along with potential causes for deferral of procedure.METHODS A retrospective study was conducted amongst the patients presenting to a 360 bedded community hospital in central Massachusetts with a diagnosis of acute meningitis syndrome between January 2010-September 2022.The electronic health records were accessed to collect necessary demographic and clinical data,including etiology of meningitis,lumbar puncture results,reason for procedure deferral,duration of antibiotic therapy and clinical outcome.The patients were subsequently divided into two groups based on whether they received a LP or not,and data was analyzed.RESULTS A total of 169 patients admitted with acute meningitis syndrome between September 2010-2022 were included in the study.The mean age of the participants was 54.3 years(SD+/-19.2 years).LP was performed for 130(76.9%)participants,out of which,28(21.5%)showed some growth in CSF culture.The most commonly identified organism was streptococcus pneumoniae.Amongst the 39 patients in whom LP was deferred,the major reasons recorded were:Body habitus(n=6,15.4%),and unsuccessful attempt(n=4,10.3%).While 93(71.5%)patients with LP received antibiotic therapy,only 19(48.7%)patients without LP received the antibiotics,with the principal reason being spontaneous improvement in sensorium without any diagnosed source of infection.The mean duration of antibiotic use was 12.3 days(SD+/-5.6)in the LP group and 11.5 days(SD+/-7.0)in the non-LP group(P=0.56;statistically not significant).We observed higher long term sequalae in the non-LP group(n=6,15.4%)compared to the LP group(n=9,6.9%).Similarly,the death rate was higher in the non-LP group(n=7,18.0%)compared to the LP group(n=9,6.9%).CONCLUSION LP remains the cornerstone for diagnosing meningitis,but often CSF results are unavailable,leading to empiric treatment.Our study identified that body habitus and unsuccessful attempts were the most common reasons for LP not being performed,leading to empiric antibiotic coverage.There was no difference between the duration of antibiotics received by the two groups,but a lower proportion of patients without LP received antibiotics,attributed to a spontaneous improvement in sensorium.However,the residual neurological sequelae and death rates were higher in patients without LP,signifying a potential under-treatment.A LP remains crucial to diagnose meningitis,and a lack of CSF analysis predisposes to under-treatment,leading to higher neurological sequelae and increased chances of death.

Comparative study between bacterial meningitis vs.viral meningitis and COVID-19

Meningitis is the inflammation of brain and spinal cord protective membrane. It is a deadly and enfeebling disease that affects people of all ages and most often caused by a bacterial or viral infection. Bacterial meningitis is a more serious and life-threatening condition, while viral meningitis the most frequent kind is often less severe and self-limiting. Therefore, successful treatment of meningitis depends on identifying the suspected or known causative organism. In this article, we aim to review the latest information about the etiology of meningitis and explore its possible occurrence and complication followed COVID-19 infection.

Frequency of Bacterial Organisms Isolated from Cerebrospinal Fluid (CSF) of Children under Five Years in Windhoek from 2010 to 2014

Bacterial meningitis (BM) is a life-threatening condition which affects the central nervous system (CNS). Its incidence rate is estimated between 0.22 - 2.66 and 0.81 - 6.1 cases/1000 lives worldwide and in Africa respectively. The objective of this study was to determine the frequency of bacterial organisms isolated from CSF of children less than five years old in Windhoek. A retrospective analysis was performed on 784 results of CSF submitted to the Namibia Institute of Pathology (NIP) from January 2010 to August 2014. The results showed that out of the suspected meningitis cases, 18 (28.6%) were due to Streptococcus pneumoniae, making it the frequently isolated organism, followed by Staphylococcus aureus 7 (11.1%), Escherichia coli 5 (7.9%) and Haemophilus influenzae 4 (6.3%). Streptococcus pneumoniae showed high resistance to penicillin 17 (70.5%) & cotrimoxazole 16 (93.7%) and 100% susceptibility to ciprofloxacin (5), vancomycin (13) & ceftri-axone (8). Haemophilus influenzae showed moderate resistance to cotrimoxazole 3 (66%) & tet-racycline 2 (50%). It showed 100% sensitivity to chloramphenicol (4), cefuroxime (2) & ceftriaxone (3). Neisseria meningitidis showed high resistance to cotrimoxazole by 100% (n = 2) and high sensitivity to chloramphenicol (n = 2), ceftriaxone & penicillin by 100% (n = 2). Streptococcus agalactiae was resistant to tetracycline and sensitive to penicillin & erythromycin by 100% (n = 1). Streptococcus pneumoniae was isolated the most in this current study and it had high resistance to penicillin & cotrimoxazole. There was a significant difference between results CSF culture and PCR, Gram stain, CSF cell count, protein & glucose, as all comparisons yielded in P values less than 0.05, indicating a significant statistical association.

Effect of salvia miltiorrhiza injection adjuvant therapy on systemic inflammatory stress state and nerve injury degree of children with bacterial Encephalitis

Objective:To discuss the effect of salvia miltiorrhiza injection adjuvant therapy on systemic inflammatory stress state and nerve injury degree of children with bacterial meningitis. Methods: 68 cases of children with bacterial meningitis who were treated in our hospital from Feb. 2014 to Jan. 2017 were selected and were divided into control group (34 cases) and observation group (34 cases) based on random number table, and patients in both groups were treated with continuous treatment for 10 d. Differences of inflammatory mediator, oxidative stress index, nerve injury markers content in cerebrospinal fluid in both groups were compared. Results: Before treatment, differences of inflammatory mediator, oxidative stress index, nerve injury markers content in cerebrospinal fluid in both groups had no statistical significance. 10 d after treatment, inflammatory mediator IL-6, PCT, sVCAM-1, CRP content in cerebrospinal fluid of children in observation group was lower than that in control group;oxidative stress index MDA content in cerebrospinal fluid was lower than that in control group, and SOD content was higher than that in control group;nerve injury markers MBP, NSE, GFAP content in cerebrospinal fluid was lower than that in control group.Conclusion: salvia miltiorrhiza injection adjuvant therapy could effectively relieve the systemic inflammatory stress state and reduce the nerve damages of children with bacterial meningitis.

A Rare Case of Aortic Valve Endocarditis and Acute Meningitis Due to Haemophilus influenzae

HACEK organisms represent a rare but important group of causative pathogens in endocarditis. These bacteria have historically been associated with culture-negative endocarditis;however, modern laboratory techniques have made this less common. In this case, we present a 74-year-old man who presented with acute onset altered mentation, fever, and sepsis. He was ultimately found to have Haemophilus influenzae meningitis, cerebral empyema, aortic valve endocarditis, psoas myositis, and L2 - L3 diskitis with osteomyelitis. Although HACEK organisms are commonly found in the oropharynx and upper respiratory tract in humans, our patient did not report recent preceding dental or ENT procedures. H. influenzae is responsible for approximately 0.16% of all cases of bacterial endocarditis, representing a very limited subset. Although generally considered low virulent pathogens, this case demonstrates the unusual extent of infection from a HACEK organism, H. influenzae, causing aortic valve endocarditis as well as atypical non-cardiac sequelae, including acute meningitis.

Concurrent tubercular and staphylococcus meningitis in a child

Spontaneous,non-surgical haematogenous Staphylococcus aureus meningitis is rare and associated with high mortality.Mixed infection causing meningitis(pyogenic and tubercular) is further rarer,poses a difficult diagnostic and management challenge,which warrants early diagnosis and aggressive therapy.We present a case of concurrent pyogenic and tubercular meningitis in a child managed successfully.It seems that in present case initial pyogenic infection resulted in the immunocompromised state for the child that would had lead to the activation of tubercular foci resulting in tubercular meningitis.

Etiologies and Outcome of Children with Purulent Meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (Cameroon)

Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 15 years admitted for purulent meningitis at the Yaounde Gyneco-Obstetric and Pediatric Hospital (YGOPH). Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2009 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 15 years who were admitted for bacterial meningitis at the YGOPH, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture or soluble antigen. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P 0.05. Results: We selected 171 cases of purulent meningitis who represented 1.54% of admitted patients. The sex ratio was 1.2. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever (98.8%), seizures (44.4%) and vomiting (28.7%). Haemophilus influenzae was found in 67 children (39.2%), followed by Streptococcus pneumoniae in 54 children (31.6%) and Neisseria meningitidis in 17 children (9.9%). Acute complications (status epilepticus, coma) were seen in 33% of patients. The statistically significant (P 0.05) factors for poor prognosis were aged from 2 months to 1 year (P = 0.0004), coma (P = 0.32), intracranial hypertension (P = 0.0001), the pathogen (P = 0.0032Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P = 0.0134) and brain abscess (P = 0.0001). We identified 32 deaths (18.7%) and 17 cases (9.9%) with neurological sequelae before discharge. Conclusion: The incidence of acute bacterial meningitis remains high in our context. The main causes were Haemophilus influenzae, Streptococcus pneumoniae and Neisseria meningitis. The mortality rate was high with poor prognosis factors such as age less than 12 months, delayed care, pneumococcal meningitis, coma, brain abscess, and intracranial hypertension. Focus should be placed on strengthening the routine immunization on vaccine-preventable diseases of infants and children against Haemophilus influenzae, Pneumococcus and Meningococcus.

Hyponatremia during a Severe Pneumococcal Meningitis with Renal Salt Wasting: A Cerebral Salt Wasting Syndrome?

Background: The existence and prevalence of cerebral salt wasting and its differentiation from syndrome of inappropriate antidiuretic hormone have been controversial. This controversy stems from overlapping clinical and laboratory findings and an inability to assess the volume status of these patients. Objectives:To present a case of a cerebral salt wasting syndrome secondary to a bacterial mengitis and to emphasize the difficulty to assess the diagnosis. Case report: A 51-year-old male admitted to the ICU for a severe bacterial meningitis who developed, four days later, hyponatremia associated with hypovolemia due to a renal salt wasting. Clinical and biological parameters were collected;electrolytes balances and salt clearances were calculated to best investigate this hydroelectrolytic disorder. Patient's volume status and improvement after fluid and sodium replacement highly suggests the diagnosis of a cerebral salt wasting syndrome. Conclusion: A thorough analysis of this case showed that occurrence of hyponatremia and renal salt wasting after brain agression is not univocal underlying the fact that the diagnosis of cerebral salt wasting should be assessed only after a careful examination of the different determinants of the hydroelectrolytical balance.

1例生痰二氧化碳嗜纤维菌脑膜炎合并肾功能亢进患儿的抗感染治疗实践

目的:探讨临床药师在儿童细菌性脑膜炎抗感染治疗中的作用。方法:临床药师通过参与1例由生痰二氧化碳嗜纤维菌引起的儿童细菌性脑膜炎患者的多次药学会诊,与医师通力合作,对患儿治疗效果欠佳的原因进行分析,结合患儿存在肾功能亢进这一特殊生理病理特点及抗菌药物药动学/药效学(PK/PD)理论,优化抗感染治疗方案并实施药学监护。结果:临床药师提出的治疗方案被医师采纳,患儿临床症状改善、脑脊液恢复正常并顺利出院。结论:临床药师对临床上罕见致病菌引起的特殊部位感染,应充分发挥药学专业特长,进一步提高抗感染药物的临床疗效。

脑脊液与血多指标联合诊断模型对神经外科细菌性脑膜炎早期诊断的价值

目的利用脑脊液与血多项实验室常规检查预测细菌性脑膜炎的脑脊液培养结果。方法回顾性分析首都医科大学北京天坛医院2020~2023年神经外科住院患者细菌性脑膜炎(357例)和无菌性脑膜炎(363例)的10项相关实验室检测结果,探究脑脊液与血多项检查对细菌性脑膜炎早期诊断的临床意义。结果经单因素分析细菌性脑膜炎组与无菌性脑膜炎组脑脊液白细胞计数(C-WBC)、脑脊液单核细胞比例(C-LY)、脑脊液蛋白浓度(C-PRO)、脑脊液乳酸(C-LAC)、血葡萄糖浓度(B-GLU)、血白细胞计数(B-WBC)、血C反应蛋白(CRP)等7项指标差异有统计学意义(P<0.05)。经多因素回归分析,两组间C-WBC与CRP的差异具有统计学意义(P=0.012,P<0.01)。通过对C-WBC和CRP进行联合诊断模型的构建,其诊断AUC=0.727,灵敏度为72.5%,特异性为61.5%。诊断模型为:Y=-1.18×10^(-4)×C-WBC-0.11×CRP+3.118。结论联合C-WBC与CRP对细菌性脑膜炎与无菌性脑膜炎可以进行有效的鉴别诊断。

细菌性脑膜炎症候群患儿菌群情况及其耐药分析

目的调查研究细菌性脑膜炎症候群患儿菌群情况以及耐药情况。方法选择199例细菌性脑膜炎症候群患儿为研究对象,采集所有患儿的脑脊液标本完成细菌培养以及药敏试验。分析病原菌分布情况及主要病原菌耐药特点。结果199例患儿脑脊液共检出病原菌61株,按照占比从高到低的顺序分别为肺炎链球菌、无乳链球菌、大肠埃希菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌、屎肠球菌、白色念球菌、脑膜炎奈瑟菌及其他,占比分别为31.15%、21.31%、19.67%、16.39%、3.28%、3.28%、1.64%、1.64%、1.64%。大肠埃希菌对亚胺培南以及美罗培南的耐药性均为0,对其他抗菌药物均有不同程度的耐药性;脑膜炎奈瑟菌对亚胺培南、美罗培南、头孢曲松以及头孢噻肟耐药性均为0,对其他抗菌药物均有不同程度的耐药性。肺炎链球菌对万古霉素的耐药性均为0,对其他抗菌药物均有不同程度的耐药性;无乳链球菌对头孢哌酮的耐药性为0,对环丙沙星的耐药率为7.69%,而对其他抗菌药物均有明显耐药性;金黄色葡萄球菌对万古霉素以及利奈唑胺的耐药性均为0,对其他抗菌药物均有不同程度耐药性;凝固酶阴性葡萄球菌对万古霉素以及利奈唑胺的耐药性均为0,对其他抗菌药物均有不同程度耐药。结论细菌性脑膜炎症候群患儿致病菌以肺炎链球菌、无乳链球菌、大肠埃希菌、金黄色葡萄球菌、凝固酶阴性葡萄球菌以及脑膜炎奈瑟菌为主,且不同致病菌对不同抗菌药物的耐药性不同,临床工作中应根据药敏试验结果合理选用抗菌药物。

儿童细菌性脑膜炎并发硬膜下积液的临床特征及危险因素分析

目的探讨儿童细菌性脑膜炎(BM)并发硬膜下积液(SE)的临床特征,并分析相关危险因素。方法回顾性分析2017年1月至2019年1月在广西壮族自治区妇幼保健院儿童神经内科住院且诊断为BM的患儿102例,其中男63例,女39例;年龄1个月~11岁,中位年龄5个月。根据头颅MRI检查是否合并SE,将患儿分为BM并发SE组和未并发SE组,比较两组患儿的一般资料、血液学及脑脊液检查结果,采用多因素logistic回归分析BM并发SE的危险因素。结果BM患儿并发SE 23例,发生率为22.5%。两组患儿年龄、惊厥、外周血CRP水平、脑脊液蛋白及葡萄糖水平比较差异均有统计学意义(均P<0.05),多因素logistic回归分析显示惊厥(OR=19.314,95%CI:1.858~200.747,P=0.013)、脑脊液葡萄糖水平降低(OR=0.186,95%CI:0.035~0.984,P=0.048)均是儿童BM并发SE的独立危险因素。结论惊厥发作、脑脊液葡萄糖水平降低与BM患儿并发SE有关,早期识别是否合并SE有助于正确判断病情,指导合理用药和调整治疗方案。

脑脊液乳酸、白细胞介素-27及干扰素-γ联合检测在神经外科术后细菌性脑膜炎中的诊断价值

目的探讨脑脊液乳酸(LA)、白细胞介素-27(IL-27)及干扰素-γ(IFN-γ)联合检测对重症监护室(ICU)神经外科术后细菌性脑膜炎的诊断价值。方法选取ICU神经外科术后细菌性脑膜炎患者54例作为疾病组,另选取62例术后无细菌性脑膜炎患者作为对照组。采用全自动生化分析仪和酶联免疫吸附法(ELISA)检测脑脊液LA、IL-27、IFN-γ表达水平;采用Logistic回归模型分析影响术后发生细菌性脑膜炎的相关因素;采用受试者工作特征(ROC)曲线分析脑脊液LA、IL-27、IFN-γ对术后细菌性脑膜炎的诊断价值。结果疾病组葡萄糖水平低于对照组,白细胞计数、蛋白质水平高于对照组,差异均有统计学意义(P<0.01)。疾病组脑脊液LA、IL-27表达水平高于对照组,而脑脊液IFN-γ表达水平低于对照组,差异均有统计学意义(P<0.01)。Logistic回归分析显示,脑脊液LA、IL-27、IFN-γ为ICU神经外科术后患者发生细菌性脑膜炎的影响因素(P<0.05)。脑脊液LA、IL-27、IFN-γ联合诊断ICU神经外科术后细菌性脑膜炎的曲线下面积(AUC)为0.955,优于脑脊液LA(AUC=0.806,Z=4.029,P<0.001)、IL-27(AUC=0.858,Z=2.513,P=0.012)、IFN-γ(AUC=0.815,Z=3.680,P<0.001)单独诊断,联合诊断的灵敏度和特异度分别为87.04%、93.55%。结论ICU神经外科术后细菌性脑膜炎患者脑脊液LA、IL-27表达水平均显著升高,而脑脊液IFN-γ水平显著较低。相较于单独检测,3项指标联合检测对术后发生细菌性脑膜炎有更高的诊断价值。