A Clinical Study Of317Cases Of Purulent Meningitis

Objective:To explore the clinical features of purulent meningitis(PM) in children,in order to early diagnose and effectivly treatment, futhermore decreasecomplication and sequelae.Methods:A total of317children aged from1months to15years old who werehospitalised in neurology department of Chongqing medical children’shospital from2007to2012were observed. All children were confirmed tobe PM. Summarize the epidemiology, clinic, laborary, imageology andprognosis. All data were analyzed by SPSS17.0software, stastisticalsignificance was set at p<0.05.Results:(1) Of all the317cases, there was no signifient difference in incidenceof season. Children aged under1years old(198cases，62.6%) was the mostfrequent population. The ratio of male to female was1.68:1. Rural was themost influence area. Respiratory infection was the leading premorbidincentive of PM. The defect of anatomical or infection nearby existed in recurrent PM such as cerebrospinal rhinorrhea，chronic otitis media andpilonidal sinus.(2) The main clinic manifestations were fever(268cases,84.5%),intracranial hypertesion(227cases,71.6%), convulsion(174cases,54.9%),consciousness (69cases，21.8%), meningeal irritation sign(128cases,40.4%). Convulsion in infants was more common compared to elderchildren, but within the age growth the mortality of intracranialhypertension and meningeal irritation sign were more common. The rate ofcomplication was estimated at33.7%, subdural effusion was the mostfrequent(29.9%) one.73cases of subdural effusion were dignosed byimaging, while22cases by subdural paracentasis. Tempureture recoveredto normal within3to5days after subdural paracentasis in most cases ofsubdural effusion. The rate of sequelae in hospital was19.2%includingsecondary epilepsy(14.5%), paralysis(6.9%) and deafness(5.1%). Age,convulsion, high cerebrospinal fluid(CSF) protein and low CSF glucosewere the influencing factors of complication and sequelae.(3) Laborary inflammation index in blood routine were abnormal in50%children,61cases(20%)>500×106/L in white blood cell(WBC) ofCSF,105cases(34.4%)>1g/L in protein of CSF,111cases(36.2%)<2mmol/L in glucose of CSF,65cases(78.3%) of CSF/serum glucoseratio≤0.6. Positive rate of CSF culture was13.7%, the main pathogens wassteptococcus pneumoniae(SP)(47.6%), while the positive rate of blood culture was13.8%, the main pathogens were staphylococcus(32%),escherichia coli(E.coli)(23%), and SP(20%).(4)Of all the234cases who accomplish Electroencephalogram(EEG),90cases(38.5%) showed slow wave,46cases(19.7%) showed epilepsydischarge. Both magnatic resonance imaging(MRI) and computedtomography(CT) could show complication such as subdural effusion.(5)Most cases had already receiced antibiotic therpy before,third-generation cephalosporin was the first choice for PM unknown ofpathogenic.Chloramphenicol, vancomycin or carbapenem werereplacement therapy if experience treatment failure. Rifampicin wasanother choice for failure of effective antibiotic. Dexamethasone or gammaglobulin was good choice for auxiliary therapy.(6) Some of children who were cured performed delay cerebralvasculitis within1-3months, which existed in those with abnomal CSF.Conclusion:(1) Infant was the most frequent population. Respiration infection wasthe leading premorbid incentice of PM, the defect of anatomical orinfection nearby existed in recurrent PM. Rural was the most influencearea.(2) The clinical manifestation of317cases were consistent withgeneral clinical features of children with PM. Subdural paracentasis wasimportant to not only dignose but also cure subdural effusion. Age, convulsion, high CSF protein, low CSF glucose were influcing factor ofcomplication and sequelae.(3) Laboratory index was usually atypical, but CSF/serum glucoseratio could be an important item help to dignose PM. SP was the mainpathogenic of CSF culture. staphylococcus, E.coli and SP were the mainpathogenic of blood culture.(4) A epilepsy discharges on electroencephalogram(EEG) was a guideto the use of antiepileptic drugs. Both MRI and CT could showcomplication of PM such as subdural effusion or hydrocephalus, but MRIwas more apply to CT in clinic.(5) Third-generation cephalosporin was the first choice for PMunknown of pathogenic, Chloramphenicol, vancomycin or carbapenemwere replacement therapy if experience treatment failure. Rifampicin wasanother choice for failure of effective antibiotic.(6) Delay vasculitis were performed among children who were cured oronly with CSF abnormal within1-3months out of hospital, follow-up visitwas necessary within1-3months or longer, and MRI could be done.