Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97
Acute bacterial meningitis in children admitted to the Queen Elizabeth Central Hospital, Blantyre, Malawi in 1996-97
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DOI：
10.1046/j.1365-3156.1998.00278.x
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发表时间：
1998-08-01
影响因子：
3.3
通讯作者：
Molyneux, M
中科院分区：
文献类型：
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作者：
Molyneux, E;Walsh, A;Molyneux, M
为了设计适当的干预措施，我们前瞻性地收集了1996年4月1日至1997年3月31日马拉维布兰太尔伊丽莎白女王中心医院(QECH)所有确诊为细菌性脑膜炎(BM)的儿童的临床和人口学数据。在研究期间，267名儿童(占所有儿科住院患者的2.7%)被发现患有BM；83%的儿童年龄在5岁以下，61%的儿童年龄在1岁以下，23%的儿童年龄在1个月以下。新生儿后期(n=206)最常见的致病菌是肺炎链球菌(27%)、b型流感嗜血杆菌(Hib)21%和鼠伤寒沙门氏菌(6%)。新生儿组(1个月，n=61)最常见的致病菌为无乳链球菌(23%)、鼠伤寒沙门菌(15%)、肺炎链球菌(11.5%)和其他革兰氏阴性杆菌(11.5%)。21例沙门氏菌感染中19例发生在1岁以下儿童，所有无乳链球菌均发生在3个月以下婴儿。出现延迟：平均发烧时间为4.6天，39.5%的患者在入院前曾抽搐，57%的患者意识水平改变。22.5%的延误可能是疟疾的初步诊断造成的(186例检测中有42例)。48%的人年龄体重为80%，18%的人年龄体重为60%。总死亡率为40%。沙门氏菌感染的结果最差，特别是新生儿沙门氏菌RM，病死率(CFR)为89%(9例中有8例)。入院时昏迷预后更差(病死率%；IF Blantyre昏迷评分<3分，IF<2分26%)。15%的幸存者在出院时有后遗症。20%的Hib菌株对氯霉素耐药，但所有沙门氏菌都是敏感的。肺炎链球菌对青霉素耐药率为5%，对氯霉素耐药率为8%。在疟疾流行地区及早获得适当的卫生保健和对BM的认识可降低死亡率和发病率，接种Hib感染疫苗本可将死亡人数减少18人(17%)，并防止7例病例出现后遗症。
To design appropriate interventions, we collected clinical and demographic data prospectively on all children aged one day to 14 years admitted with a diagnosis of bacterial meningitis (BM) from April 1st 1996 to March 31st 1997 to the Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi. During the study period 267 children (2.7% of all paediatric admissions) were found to have BM; 83% were under 5 years of age, 61% under one year and 23% under one month. The most common causative organisms in the post neonatal period (n = 206) were Streptococcus pneumoniae (27%), Haemophilus influenzae type b (Hib) 21%, and Salmonella typhimurium (6%). In the neonatal group (< 1 month, n = 61) the most common causes were Streptococcus agalactiae (23%), S. typhimurium (15%), S. pneumoniae (11.5%) and other Gram negative rods (11.5%). Nineteen of 21 salmonella infections were in children under one year of age and all S. agalactiae were in infants under three months. There was delay on presentation: the average length of fever was 4.6 days, 39.5% had convulsed prior to arrival and 57% had an altered level of consciousness. An initial diagnosis of malaria had probably contributed to the delay in 22.5% (42 of 186 tested). 48% were < 80% weight for age, with 18% < 60% weight for age. The overall mortality was 40%. The outcome was worst in salmonella infections, particularly neonatal salmonella RM with a case fatality rate (CFR) of 89% (8 of 9 cases). Coma on presentation worsened prognosis (mortality 64%; if Blantyre Coma Score < 3, 26% if > 3). 15% of survivors had sequelae on discharge. 20% of Hib isolates were resistant to chloramphenicol, but all salmonellae were sensitive. 5% of S. pneumoniae were resistant to penicillin and 8% to chloramphenicol. Earlier access to adequate health care and awareness of BM in a malaria-endemic area mould reduce mortality and morbidity Vaccination against Hib infection would have reduced death by 18 (17%) and prevented sequelae in 7 cases.