Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.
Etiologies and Management of Aseptic Meningitis in Patients Admitted to an Internal Medicine Department.
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DOI：
10.1097/md.0000000000002372
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发表时间：
2016-01
期刊：
影响因子：
1.6
通讯作者：
Lloret-Linares C
中科院分区：
文献类型：
--
作者：
Jarrin I;Sellier P;Lopes A;Morgand M;Makovec T;Delcey V;Champion K;Simoneau G;Green A;Mouly S;Bergmann JF;Lloret-Linares C
一些研究集中在脑膜炎的临床和生物学特征，以区分细菌性和病毒性脑膜炎在紧急情况下。然而，很少有人知道的病因和结果的无菌性脑膜炎的病人承认内科。本研究的目的是描述内科收治的成人无菌性脑膜炎伴或不伴脑炎的病因、特征和转归。一项回顾性队列研究于2009年1月至2011年12月在法国巴黎Lariboisière医院内科进行。记录无菌性脑膜炎的临床和生物学特征。这些包括脑脊液分析，聚合酶链反应检测结果，最终诊断和治疗管理。该队列包括180例符合无菌性脑膜炎伴（n = 56）或不伴（n = 124）脑炎标准的患者。 在180例病例中，83例确定了明确的病因诊断。在确诊病例中，73例为感染性病原体，主要为肠道病毒、单纯疱疹病毒2型和水痘带状疱疹病毒（分别为43.4%、16.8%和14.5%）。炎症性疾病7例。在97例没有明确诊断的病例中，26例（26.8%）在整个治疗过程中一直没有接受治疗，而其余71例患者在急诊科开始接受抗病毒或抗生素治疗。只有10名被认为患有病毒性脑膜炎的患者在入院时停止了治疗。在因无菌性脑膜炎而入院的患者中，炎症性疾病的患病率并不罕见（占总体无菌性脑膜炎的4%）。急诊科入院时的PCR对于及时优化治疗和管理显然具有重要意义。然而，根据本回顾性研究中强调的几个临床和生物学特征，也可以区分病毒性脑膜炎或炎性疾病。由于目前已有关于病毒性脑膜炎抗病毒药物处方的建议，预计未来将有更好的治疗管理。
Several studies have focused on the clinical and biological characteristics of meningitis in order to distinguish between bacterial and viral meningitis in the emergency setting. However, little is known about the etiologies and outcomes of aseptic meningitis in patients admitted to Internal Medicine. The aim of the study is to describe the etiologies, characteristics, and outcomes of aseptic meningitis with or without encephalitis in adults admitted to an Internal Medicine Department. A retrospective cohort study was conducted in the Internal Medicine Department of the Lariboisière Hospital in Paris, France, from January 2009 to December 2011. Clinical and biological characteristics of aseptic meningitis were recorded. These included cerebrospinal fluid analysis, results of polymerase chain reaction testing, final diagnoses, and therapeutic management. The cohort included 180 patients fulfilling the criteria for aseptic meningitis with (n = 56) or without (n = 124) encephalitis. A definitive etiological diagnosis was established in 83 of the 180 cases. Of the cases with a definitive diagnosis, 73 were due to infectious agents, mainly enteroviruses, Herpes Simplex Virus 2, and Varicella Zoster Virus (43.4%, 16.8%, and 14.5% respectively). Inflammatory diseases were diagnosed in 7 cases. Among the 97 cases without definitive diagnoses, 26 (26.8%) remained free of treatment throughout their management whereas antiviral or antibiotic therapy was initiated in the emergency department for the remaining 71 patients. The treatment was discontinued in only 10 patients deemed to have viral meningitis upon admission to Internal Medicine. The prevalence of inflammatory diseases among patients admitted to internal medicine for aseptic meningitis is not rare (4% of overall aseptic meningitis). The PCR upon admission to the emergency department is obviously of major importance for the prompt optimization of therapy and management. However, meningitis due to viral agents or inflammatory diseases could also be distinguished according to several clinical and biological characteristics highlighted in this retrospective study. As recommendations are now available concerning the prescriptions of antiviral agents in viral meningitis, better therapeutic management is expected in the future.