Scrub Typhus Meningitis versus Acute Bacterial Meningitis-A Clinical-Laboratory Differential Diagnosis
Scrub Typhus Meningitis versus Acute Bacterial Meningitis-A Clinical-Laboratory Differential Diagnosis
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DOI：
10.1055/s-0037-1601339
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发表时间：
2017-06-01
影响因子：
0.3
通讯作者：
Ahmed, Sohaib
中科院分区：
文献类型：
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作者：
Bhat, Nowneet Kumar;Ahuja, Vivek;Ahmed, Sohaib
神经系统受累的恙虫病的形式脑膜炎或脑膜脑炎，其区别于其他形式的细菌性和病毒性脑膜炎，还没有广泛的研究，在儿科人群。我们比较了印度北部一所大学教学医院的恙虫病性脑膜炎（STM）和急性细菌性脑膜炎（ABM）患儿的临床和实验室资料。27名儿童在12个月内被诊断患有急性脑膜炎。根据临床特征和异常脑脊液（CSF）分析诊断脑膜炎，其中恙虫病IgM ELISA阳性（n = 19）或从CSF中分离出已知引起ABM的细菌（n = 8）。与ABM组相比，STM组的儿童年龄明显更大（7.8 ± 4.9 vs. 4.5 ± 4.9岁; p = 0.029），发热持续时间更长（7.9 = 2.7 vs. 3.4 = 2.1天; p < 0.001），并且更可能有多系统受累。STM组脑脊液细胞增多程度较轻（99.2 +/- 103.4 vs. 1770 +/-3，333 cells/mm（3）; p < 0.001），CSF中淋巴细胞比例较高（74 +/- 16 vs. 12 +/- 6.8%; p < 0.001），蛋白质升高程度较低（108.4 +/- 43.9 vs. 639.0 +/- 546.3 mg%; p < 0.001），以及与ABM组相比更高的CSF糖水平（60.8 +/- 13.1 vs. 21.6 +/- 11.6 mg%; p < 0.001）。STM患儿退热时间较短。总之，与ABM儿童相比，STM儿童往往年龄较大，通常有多系统受累，发热持续时间较长，但对适当的抗生素反应更快。典型的CSF检查结果包括淋巴细胞增多、中度蛋白质升高和正常葡萄糖浓度。
Neurologic involvement in scrub typhus in the form of meningitis or meningoencephalitis, and its differentiation from other forms of bacterial and viral meningitis, has not been extensively studied in pediatric population. We compared the clinical and laboratory profiles of children with scrub typhus meningitis (STM) and acute bacterial meningitis (ABM) at a university teaching hospital in North India. Twenty-seven children were diagnosed with acute meningitis over 12 months. Meningitis was diagnosed based on clinical features and abnormal cerebrospinal fluid (CSF) analysis, with either a positive IgM ELISA for scrub typhus (n = 19) or isolation of bacteria known to cause ABM from CSF (n = 8). The children with STM were significantly older (7.8 +/- 4.9 vs. 4.5 +/- 4.9 years; p = 0.029), had longer duration of fever (7.9 = 2.7 vs. 3.4 = 2.1 days; p < 0.001), and were more likely to have multisystem involvement compared with ABM group. The STM group had CSF pleocytosis of lessermagnitude (99.2 +/- 103.4 vs. 1770 +/- 3,333 cells/mm(3); p < 0.001), a higher proportion of lymphocytes in CSF (74 +/- 16 vs. 12 +/- 6.8%; p < 0.001), lesser degree of protein elevation (108.4 +/- 43.9 vs. 639.0 +/- 546.3 mg%; p < 0.001), and higher CSF sugar level (60.8 +/- 13.1 vs. 21.6 +/- 11.6 mg%; p < 0.001) as compared with ABM group. Time to defervescence in children with STM was shorter. In conclusion, compared with ABM children, STM children tended to be older, usually had multisystem involvement, and had longer duration of fever but more rapid defervescence in response to appropriate antibiotics. Typical CSF findings included lymphocytic pleocytosis, moderate protein elevation, and a normal glucose concentration.