儿童不同病原菌所致化脓性脑膜炎的影像学特征
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摘要
目的:探讨儿童不同病原菌化脓性脑膜炎(简称化脑)的特征性影像学改变。方法:回顾性分析2011年1月至2017年12月在我院收集的123例病原菌明确的化脑患儿的临床及影像学资料。结果:肺炎链球菌(35/123,28.5%)、大肠埃希菌(26/123,21.1%)和葡萄球菌(27/123,22.0%)是最常见的致病菌。最常见的影像学表现为脑膜强化(57.5%,54/80)、硬膜下积液(33.3%)、脑炎(21.2%)、脑梗死/软化灶(17.9%)、脑积水(15.4%)、硬膜下积脓(11.4%)是其常见并发症,室管膜炎(4.0%)以及脑出血(8.1%)较少见。多中心性梗死为链球菌性脑膜炎的典型改变;脑室扩张较常见于大肠埃希菌性脑膜炎;硬膜下积液、积脓及脑组织广泛异常信号,提示流感嗜血杆菌感染;多发脑脓肿提示沙雷菌性脑膜炎。结论:不同病原菌所致化脑在影像学上具有特征性改变,这些影像特征将有助于临床诊断及治疗。
Purpose: To investigate the character imaging changes of purulent meningitis caused by different pathogens in children. Methods: The clinical and imaging data of 123 children with specific pathogenic bacteria were analyzed retrospectively from January 2011 to December 2017. Results: Streptococcus pneumoniae(35/123, 28.5%)and Escherichia coli(26/123,21.1%) and staphylococcus(27/123, 22.0%) were the most common pathogenic bacteria.The most common imaging manifestation was meningeal enhancement(57.5%, 54/80).The common complications were subdural effusion(33.3%), encephalitis(21.2%), cerebral infarction/malacia(17.9%), hydrocephalus(15.4%),and subdural pyosis(11.4%), ependymitis(4.0%) and intracerebral hemorrhage(8.1%) were rare. Multicentric infarction was a typical change of streptococcal meningitis; ventricular dilatation was more common in Escherichia coli meningitis; subdural effusion/pyosis with extensive abnormal signal/density of brain tissue suggested haemophilus influenzae infection; multiple brain abscesses suggested Shareh's bacillus meningitis. Conclusion: The purulent meningitis caused by different pathogens has different image characteristics, and these specific imaging features will contribute to clinical diagnosis and treatment.
Purpose: To investigate the character imaging changes of purulent meningitis caused by different pathogens in children. Methods: The clinical and imaging data of 123 children with specific pathogenic bacteria were analyzed retrospectively from January 2011 to December 2017. Results: Streptococcus pneumoniae(35/123, 28.5%)and Escherichia coli(26/123,21.1%) and staphylococcus(27/123, 22.0%) were the most common pathogenic bacteria.The most common imaging manifestation was meningeal enhancement(57.5%, 54/80).The common complications were subdural effusion(33.3%), encephalitis(21.2%), cerebral infarction/malacia(17.9%), hydrocephalus(15.4%),and subdural pyosis(11.4%), ependymitis(4.0%) and intracerebral hemorrhage(8.1%) were rare. Multicentric infarction was a typical change of streptococcal meningitis; ventricular dilatation was more common in Escherichia coli meningitis; subdural effusion/pyosis with extensive abnormal signal/density of brain tissue suggested haemophilus influenzae infection; multiple brain abscesses suggested Shareh's bacillus meningitis. Conclusion: The purulent meningitis caused by different pathogens has different image characteristics, and these specific imaging features will contribute to clinical diagnosis and treatment.
引文
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[13]Vinchon M,Joriot S,Jissendi-Tchofo P,et al.Post meningitis subdural fluid collection in infants:changing pattern and indications for surgery.J Neurosurg,2006,104:383-387.
[14]Centeno R S,Winter J,Bentson J R,et al.CT evaluation of haemophilus influenzae meningitis with clinical and pathologic correlation.Computerized Radiology,1983,7:243-249.
[15]Polin R A,Harris M C.Neonatal bacterial meningitis.//Seminars in neonatology:SN.2001:157-172.
[2]Tan YC,Gill AK,Kim K S.Treatment strategies for central nervous system infections.Expert Opinion on Pharmacotherapy,2015,16:187-203.
[3]刘晓雪,张先慧,徐胜平,等.2007-2014年济南市急性脑炎脑膜炎病例的流行特征分析.现代预防医学,2016,42:3296-3299.
[4]蒋鸿超,奎莉越,黄海林,等.116例细菌性脑膜炎儿童脑脊液病原菌分布及耐药性分析.中国当代儿科杂志,2013,15:264-267.
[5]Edmond K,Clark A,Korczak V S,et al.Global and regional risk of disabling sequelae from bacterial meningitis:a systematic review and meta-analysis.Lancet Infectious Diseases,2010,10:317-328.
[6]Mccormick D W,Wilson M L,Mankhambo L,et al.Risk Factors for Death and Severe Sequelae in Malawian Children with Bacterial Meningitis,1997-2010.Pediatric Infectious Disease Journal,2013,32:e54.
[7]Saha S K,Khan N Z,Ahmed A S,et al.Neurodevelopmental sequelae in pneumococcal meningitis cases in Bangladesh:a comprehensive follow-up study.Clinical Infectious Diseases,2009,48 Suppl2(Supplement_2):S90-96.
[8]Jaremko J L,Moon A S,Kumbla S.Patterns of complications of neonatal and infant meningitis on MRI by organism:a 10 year review.European Journal of Radiology,2011,80:821-827.
[9]Jorens PG,Parizel PM,Wojciechowski M,et al.Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions.Eur J Paediatr Neurol 2008;12:127-132.
[10]Kato Y,Takeda H,Dembo T,et al.Delayed recurrent ischemic stroke after initial good recovery from pneumococcal meningitis.Intern Med,2012,51:647-650.
[11]Gendelman H E,Persidsky Y.Infections of the nervous system.Lancet Neurology,2005,4:12-13.
[12]Prajogo E,Salimo H,Netty R H,et al.Acute bacterial meningitis in infants and children.Paediatrica Indonesiana,2010,23:55.
[13]Vinchon M,Joriot S,Jissendi-Tchofo P,et al.Post meningitis subdural fluid collection in infants:changing pattern and indications for surgery.J Neurosurg,2006,104:383-387.
[14]Centeno R S,Winter J,Bentson J R,et al.CT evaluation of haemophilus influenzae meningitis with clinical and pathologic correlation.Computerized Radiology,1983,7:243-249.
[15]Polin R A,Harris M C.Neonatal bacterial meningitis.//Seminars in neonatology:SN.2001:157-172.