Diagnosis of acute bacterial meningitis in children at a district hospital in sub-Saharan Africa
Diagnosis of acute bacterial meningitis in children at a district hospital in sub-Saharan Africa
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DOI：
10.1016/s0140-6736(00)04897-2
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发表时间：
2001-06-02
期刊：
影响因子：
168.9
通讯作者：
Newton, CRJC
中科院分区：
文献类型：
--
作者：
Berkley, JA;Mwangi, I;Newton, CRJC
背景在撒哈拉以南非洲，儿童急性细菌性脑膜炎的诊断很困难，因为其临床特征与其他常见疾病重叠，而且许多地区的实验室设施不足。我们已经评估了非实验室检查和不完整的实验室数据在诊断儿童急性细菌性脑膜炎在此setting.Methods的价值，我们前瞻性研究了905名儿童接受腰椎穿刺在肯尼亚农村地区医院超过1年。我们相关的微生物结果和脑脊液（CSF）实验室测量的测试，通常是在这样的hospital.Findings急性细菌性脑膜炎被证明在45名儿童（5. 0%[95% CI 3. 7 - 6. 6]）和可能在26（2. 9%[1. 9 - 4. 2]）。71例确诊或疑似急性细菌性脑膜炎中21例无颈强直或脑脊液混浊。在45名确诊为该病的儿童中，有8名的CSF白细胞计数低于10 × 10（6）/L或由于血染而无法进行白细胞计数。45例确诊为急性细菌性脑膜炎的儿童中，除2例外，其余均检出白细胞计数≥ 50 × 10（6）/L或脑脊液/血糖比值≤ 0.10;这两个样本是严重的血染。解释儿童急性细菌性脑膜炎的诊断很可能错过了三分之一的情况下，在地区医院，撒哈拉非洲没有足够和可靠的实验室资源。CSF培养设施昂贵且难以维护，使用精确的白细胞计数和葡萄糖测量设施可以获得更大的收益。
Background The diagnosis of acute bacterial meningitis in children is difficult in sub-Saharan Africa, because the clinical features overlap with those of other common diseases, and laboratory facilities are inadequate in many areas. We have assessed the value of non-laboratory tests and incomplete laboratory data in diagnosing childhood acute bacterial meningitis in this setting.Methods We prospectively studied 905 children undergoing lumbar puncture at a rural district hospital in Kenya over 1 year. We related microbiological findings and cerebrospinal-fluid (CSF) laboratory measurements to tests that would typically be available at such a hospital.Findings Acute bacterial meningitis was proven in 45 children (5.0% [95% CI 3.7-6.6]) and probable in 26 (2.9% [1.9-4.2]). 21 of the 71 cases of proven or probable acute bacterial meningitis had neither neck stiffness nor turbid CSF. In eight of 45 children with proven disease the CSF leucocyte count was less than 10x10(6)/L or leucocyte counting was not possible because of blood-staining. The presence of either a leucocyte count of 50x10(6)/L or more or a CSF/blood glucose ratio of 0.10 or less detected all but two of the 45 children with proven acute bacterial meningitis; these two samples were grossly blood-stained.Interpretation The diagnosis of childhood acute bacterial meningitis is likely to be missed in a third of cases at district hospitals in sub-Saharan Africa without adequate and reliable laboratory resources. CSF culture facilities are expensive and difficult to maintain, and greater gains could be achieved with facilities for accurate leucocyte counting and glucose measurement.