Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases.
Adult meningitis in a setting of high HIV and TB prevalence: findings from 4961 suspected cases.
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DOI：
10.1186/1471-2334-10-67
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发表时间：
2010-03-15
影响因子：
3.7
通讯作者：
Harrison TS
中科院分区：
文献类型：
--
作者：
Jarvis JN;Meintjes G;Williams A;Brown Y;Crede T;Harrison TS
由于艾滋病毒，南非成人脑膜炎的表现形式和病因发生了重大变化。对脑膜炎患者的病因学和实验室检查结果的了解在指导治疗方面很重要。我们在开普敦艾滋病和结核病高流行的背景下进行了一项回顾性研究，以确定这些发现。研究对象为2006年1月1日至2008年12月31日在公立转诊医院接受腰椎穿刺的患者。病例通过微生物学诊断进行分类，或在缺乏确定的微生物学的情况下，分类为1）正常CSF（中性粒细胞≤ 1 × 106/L，淋巴细胞≤ 5 × 106/L，蛋白质≤ 0.5 g/dL，葡萄糖≥ 1.5 mmol/L），2）轻微异常（嗜中性粒细胞2 - 5，淋巴细胞6 - 20，蛋白质0.51 - 1.0，葡萄糖1.0 - 1.49）或3）显著异常（嗜中性粒细胞> 5，淋巴细胞> 20，蛋白质> 1.0，葡萄糖<1.0）。对4549名患者进行了5578次LP，代表4961次临床发作。其中，2293例CSF正常，931例轻微异常，未确定病因。在其余的1737例中，820例（47%）获得了微生物诊断。隐球菌占微生物学诊断的63%（514），结核占28%（227），细菌性脑膜炎占8%（68）。在其余917例有明显异常的患者中，大多数（59%）有无菌淋巴细胞CSF。值得注意的是，16%（81例）确诊的隐球菌病患者、5%（12例）结核病患者和4%（3例）细菌性脑膜炎患者的CSF细胞计数和生物化学正常。隐球菌性脑膜炎和结核性脑膜炎是目前成人脑膜炎最常见的病因。结核性脑膜炎很可能在实验室检查中诊断不足，大量无菌淋巴细胞明显异常的脑脊液就是证据。
The presentation and causes of adult meningitis in South Africa have changed substantially as a result of HIV. Knowledge of aetiology and laboratory findings in patients presenting with meningitis are important in guiding management. We performed a retrospective study to determine these findings in a setting of high HIV and TB prevalence in Cape Town. Patients undergoing lumbar punctures between 1st January 2006 and 31st December 2008 at a public sector referral hospital were studied. Cases were classified by microbiological diagnosis, or in the absence of definitive microbiology as 1) normal CSF (neutrophils ≤ 1 × 106/L, lymphocytes ≤ 5 × 106/L, protein ≤ 0.5 g/dL, glucose ≥1.5 mmol/L), 2) minor abnormalities (neutrophils 2-5, lymphocytes 6-20, protein 0.51-1.0, glucose 1.0-1.49) or 3) markedly abnormal (neutrophils>5, lymphocytes>20, protein>1.0, glucose<1.0). 5578 LPs were performed on 4549 patients, representing 4961 clinical episodes. Of these, 2293 had normal CSF and 931 had minor abnormalities and no aetiology identified. Of the remaining 1737, microbiological diagnoses were obtained in 820 (47%). Cryptococcus accounted for 63% (514) of microbiological diagnoses, TB for 28% (227), bacterial meningitis for 8% (68). Of the remaining 917 who had marked abnormalities, the majority (59%) had a sterile lymphocytic CSF. Of note 16% (81) patients with confirmed Cryptococcus, 5% (12) with TB and 4% (3) with bacterial meningitis had normal CSF cell-counts and biochemistry. Cryptococcal and tuberculous meningitis are now the commonest causes of adult meningitis in this setting. TB meningitis is probably underdiagnosed by laboratory investigation, as evidence by the large numbers presenting with sterile lymphocytic markedly abnormal CSFs.
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影响因子：
6.4
作者：
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通讯作者：
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