Clinical features and risk factors analysis on 69 children of epidemic cerebrospinal meningitis / 中国小儿急救医学

ABSTRACT

Objective To improve the diagnosis and treatment of epidemic cerebrospinal meningitis in children.Methods A retrospective review was performed and a total of 69 cases of children epidemic cerebrospinal meningitis were collected and classified into ordinary and fulminant epidemic cerebrospinal meningitis from 1999 to 2011.Disease prevalent season,age,clinical characteristics,laboratory examination,treatment,prognosis and risk factors were analyzed.Results The mean age(33 male and 36 female) was (6.85 ±5.12)years old,ranging from 56 days to 15 years old.A total of 60 cases began on January to May; 6 cases began on June to October; 3 cases began on November to December.All of the 42 cases of ordinary epidemic meningitis were recovered; 7 cases of fulminant epidemic meningitis(n =27) were dead.All of the patients had fever; 64 cases(92.75％) had Petechiae petechial skin; 36 cases(52.17％) had headache; 49 cases(71.01％) vomited; 65 cases(94.2％) had positive neck resistance; 15 cases(21.74％) had convulsion; 35 cases(50.72％) had drowsiness or coma; 32 cases (46.38％) had positive pathological signs and 24 cases (34.78％) had low blood pressure or shock.Blood tests revealed that 63.77％ of the patients leukocytes raised and 8.70％ of the patients reduced; 42.03％ of the patients platelet reduced; 55.07％ of the patients had electrolyte disturbance and 89.86％ of the patients had coagulation disorders,among which 46.38％ fibrinogen reduced.The rash printed piece and cerebrospinal fluid smear tests found that Gram-negative bacteria positive rate were 12.5％ and 19.35％ respectively; the positive rate in bacterial culture of cerebrospinal fluid and blood culture were 12.90％ and 7.25％ respectively.Drug sensitive test showed that penicillin and ceftriaxone were sensitive to bacteria.The differences of age,leukocyte and platelet counts,fibrinogen and altered mental status between ordinary and fluminant epidemic meningitis were significant (P ＜ 0.05).Conclusion The prevalent season is from January to May and the prevalent age is less than 5 years for children with epidemic cerebrospinal meningitis.Ceftriaxone or penicillin should be the preferred choice;age,lower leukocyte and platelet counts,lower fibrinogen and altered mental status should be used to predict the severity of the disease.