ABSTRACT
Objective To investigate the clinical manifestations,treatment,prognosis of purulent meningitis caused by Streptococcus agalactiae in young infants.Methods The clinical data,treatment and prognosis of 15 young infants with purulent meningitis caused by Streptococcus agalactiae admitted to Qingdao Women and Children's Hospital from January 2013 to May 2016 were analyzed retrospectively.Results The cerebrospinal fluids of 15 cases aged 5 days to 3 months were all accorded with the diagnostic criteria of purulent meningitis and cultivated Streptococcus agalactiae.All of them had fever,10 cases with restlessness or irritability,7 cases with convulsions,5 cases with drowsiness,and 3 cases with sucking rejection or vomiting milk.Seven cases had subdural effusion,intracranial hemorrhage in 3 cases,hydrocephalus in 2 cases,and central respiratory failure in 1 case.All cases had complications,including pneumonia in 8 cases,sepsis in 6 cases,diarrhea in 1 case,and septic shock in 5 cases.The white blood cells were reduced in 13 cases.The serum of procalcitonin and C-reactive protein were elevated in 14 infants.The level of white blood cells in 4 cases' cerebrospinal fluid was ＞5 000 × 106/L,(1 000-5 000) × 106/L in 5 cases,＜ 1 000 × 106/L in 6 cases.The glucoses of cerebrospinal fluid were all ＜ 2.54 mmol/L,the protein of cerebrospinal fluid was all elevated (781-3 000 mg/L).In 14 cases,the head MRI and electroencephalogram(EEG) examination were completed within 1 week after admission.The head MRI showed normal in 2 cases,subdural effusion in 7 cases,intracranial hemorrhage in 3 cases,and hydrocephalus in 2 cases.EEG showed normal in 12 cases,and background activity slowed down in 2 cases.All cases had Streptococcus agalactiae growth in cerebrospinal fluid cultures.The sensitive rates to Linezolid,Vancomycin Ampicillin and Tigecycline were 100％.Ceftriaxone combined with Penicillin,Penicillin combined with Vancomycin or Vancomycin combined with Meropenem were the main combined therapy.Three out of 7 subdural effusion cases were treated with subdural drainage.Twelve cases were improved and discharged.Two cases lost to follow-ups after 2 weeks treatment.One case died after his giving up of treatment.Follow-up period was from 1 month to 3.5 years,6 cases had a normal development and 6 cases had motor retardation.Conclusions Purulent meningitis caused by Streptococcus agalactiae in the neonates and infants is more difficult in clinical treatment.High proportions of severe cases exist,some cases will have sequelae.It is imperative to apply sensitive antibiotics in time and timely prevention.
ABSTRACT
Objective To explore the recovery time of hepatic function in infants with jaundice type of human cytomega-lovirus (HCMV) hepatitis and its influencing factors. Methods The clinical data of 73 infants with jaundice type of HCMV hepa-titis admitted to hospital from February 2005 to October 2012 were retrospectively analyzed. The effects on hepatic function of nine factors including age, sex, liver size, total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT), aspar-tate aminotransferase (AST), total bile acid (TBA) and the loads of HCMV DNA were assessed by Kaplan Meier method, and further analyzed by Cox proportional hazards regression model. Results The results of Cox proportional hazards regression showed that age≤3 month (RR=0.27, 95%CI:0.10-0.70), DBil≤90μmol/L (RR=0.16, 95%CI:0.08-0.32), male (RR=0.49, 95%CI:0.26-0.94) and enlarged liver size<3 cm (RR=0.50, 95%CI:0.27-0.93) were independent factors that shorten the time for TBil back to be normal. Furthermore, AST≤120 U/L (RR=0.16, 95%CI:0.08-0.33) and enlarged liver size<3 cm (RR=0.28, 95%CI:0.15-0.49) were independent factors that shorten the time for AST back to be normal. The time for TBil back to be normal was (2.23 ± 1.54) months, which was significantly shorter than that [(3.63 ± 1.93) months] of AST (t=10.37, P<0.001). Conclusions Jaundice type HCMV hepatitis had good outcome and varied in disease course. The recovery of hepatic function was significantly adversely affected by the degree of cholestasis and hepatomegaly as well as AST level, and early treatment was conducive to the recovery.