Clinical Analysis Of 160 Cases Of Pediatric Purulent Meningitis

Objective: To summarize and analyze clinical characteristics,treatment and prognosis of pediatric purulent meningitis , in order to help to make early diagnosis,get reasonable treatment and improve prognosis.Methods: Collected the clinical data of 160 children of purulent meningitis admitted into Children's Hospital of Chongqing Medical Uni -versity from 2009 to 2010, whose cerebrospinal fluid were collected within 24-48 hours ,then analyzed their age and sex distribution, clinical manifestations, laboratory examinations , neuroimaging examinations, elec -troencephalogram, complications and treatment retrospectively.Results:(1) In the cases studied, there were 98 males and 62 females, the gender ratio (male-to-female) was 1.58:1. The age range was from 29 days to 14 years and 7 months. 29 days~1year, 1~6years,>6 years were accounted for 57.5%, 15.0%, 27.5% respectively. The lengh of stay was from 2 days to 53 days,the average was 15.07 days.(2)Chief clinical manifestations: fever(91.3%),vomiting(66.9%), convulsion(52.5%),depression(53.8%),meningeal irritation sign (52.5%).11 patiens(6.6%)were misdiagnosed in the initial stage, in which there were 5 infants.4 patients were misdiagnosed as respiratory infection,3 as epilepsy.(3)CSF routine and biochemistry examinations: There were 76 patients accounted for 47.5% with WBC more than 100×10~6/L,63 patients accounted for 39.4% with polykaryocyte accounted for more than 50%,24 patients accounted for 15.4% with glucose below 2.0mmol/L,69 patients accounted for 43.9% with protein between 0.45 and 1.0g/L,49 patients accounted for 31.2% with protein more than 1.0g/L. The chlorides were between 89.8 and 148.4 mmol/L, the average was 117.5mmol/L.(4)In the 160 cases studied,154 cases were made CSF smear, only 1 was positive.154 case were made CSF culture,4(2.5%)were positive.57 cases were made blood cultrue,8(14.0%)were positive.(5)In the 160 cases,94 cases were made cranial CT, 48.9% of which were abnormal; While 72 cases were made cranial MRI,63.9% of which were abnormal.(6)Antibiotics: Most cases were treated with penicillin and trisub -stituted cephalosporin.The number and percentage of Ceftizoxime, Ceftriaxone, and Ceftazidime were respectively 87(54.4%),27(16.9%),28(17.5%).14 cases were changed into trisubstituted cephalosporin and vancomycin, while 9 to trisubstituted cephalosporin and chloramphenicol.8 cases were used Meropenem, while 5 cases were used immunoglobin 2g/Kg. (7)In the 160 cases,112 recoveried(70.0%),42 improved(26.3%),5 gave up(3.1%),1 died(0.6%).57 cases had complications, accounted for 35.6%,among which 35 were subdural effusion(61.4%),8 were hydrocephalus(14.0%),8 were epilepsy(14.0%).(8)In the 160 cases,there were 10 recurrent purulent meningitis,with 8 males and 2 females. The age range was from 3 years and 4 months to 14 years, the average was 8 years. The motivations of recurrent were CSF rhinorrhea and/or otorrhea for 4 cases, otitis media and mastoiditis for 2 cases, Chairi deformation for 2 cases, skull fracture for 2 case, 1 with unknown reason.Conclusions:(1)The highest incidence of purulent meningitis was infants and the incidence of boys was higher than girls.(2)Then main manifestations of infants were fever, convulsion, depression,restless and irritation, with bregma distension and high tension; While the children were fever, headache, vomiting and meningeal irritation sign.The CSF was not typical with WBC always more than 100×10~6/L, and protein slightly to morderately increasing, always more than 0.45g/ L.Glucose and chloride were not decreasing obviously.Blood leucocyte always increased. The positive rate of bacteria culture was low.(3)The positive rate of neural imaging was high,which can help to discover complications early. (4)In the 160 cases,the incidence of complication was high relative -ly, so neural imaging should made as early as possible to get early treatment.(5)In the 160 cases, the most common motivation of recurrent purulent meningitis was abnormal cranial anatomy. Therefore, to recurrent purulent meningitis we should search and remove the motivations to prevent recurrent.