成人肺炎球菌脑膜炎的临床特征、并发症和结局：前瞻性病例系列（Lancet Neurology）
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Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series
Martijn Weisfelt MDa, Diederik van de Beek MDa, Lodewijk Spanjaard MDb, Johannes B Reitsma MDc and Jan de Gans MDa, ,
aDepartment of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands
bDepartment of Medical Microbiology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands
cDepartment of Clinical Epidemiology and Biostatistics, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands
The Lancet Neurology, Volume 5, Issue 2, February 2006
Summary
Background
Bacterial meningitis is a grave disease of high incidence, especially in less developed countries. Here, we describe its clinical presentation, spectrum of complications, prognostic factors, and outcome in adults with pneumococcal meningitis.
Methods
From October, 1998, to April, 2002, we assessed 352 episodes of community-acquired pneumococcal meningitis, confirmed by culture of cerebrospinal fluid (CSF), which occurred in patients older than 16 years. Predictors for an unfavourable outcome (Glasgow outcome scale score 1–4) were identified by logistic regression with multiple imputation techniques.
Findings
245 (70%) episodes of pneumococcal meningitis were associated with an underlying disorder. Cranial CT was done for 85% of episodes and revealed underlying disorders in 17% (50/299) and meningitis-associated intracranial complications in 39% (117/299). Independent predictors for an unfavourable outcome were a low score on the Glasgow coma scale, cranial nerve palsies, a raised erythrocyte sedimentation rate, a CSF leucocyte count less than 1000 cells per mm3, and a high CSF protein concentration on admission. Overall in-hospital mortality was 30%. Prevalence of neurological and systemic complications did not differ between patients aged younger than 60 years and those aged 60 years and older; however, systemic complications were the cause of death in 59% (32/54) of fatal episodes in patients aged 60 years and older, whereas neurological complications were the cause of death in 65% (20/31) of fatal episodes in younger patients.
Interpretation
Pneumococcal meningitis is associated with high mortality and morbidity rates in adults. Whereas neurological complications are the leading cause of death in younger patients, elderly patients die predominantly from systemic complications.
成人肺炎球菌脑膜炎的临床特征、并发症和结局：前瞻性病例系列
摘要
背景
细菌性脑膜炎是有很高的发病率的严重疾病，尤其是在不发达国家。这里，我们描述成人肺炎球菌脑膜炎的临床特征、并发症的种类、影响预后的因素和结局
方法
自1998年10月至2002年4月，我们评估了352例发生在16岁以上的患者，由脑脊液培养确诊的社区获得性肺炎球菌脑膜炎，用带有对数衰减的多重归因方法评定不良结局的预期因子（Glasgow结局评分1–4）。
发现（结论？）
245例（70%）的肺炎球菌脑膜炎与潜在疾病有关，85%的患者行头CT检查，其中17%显示出有潜在的疾病（50/299），有39%的患者显示有脑膜炎相关的颅内并发症（117/299）。不良预后的独立因素是Glasgow昏迷评分低，颅神经瘫痪，ESR升高，脑脊液中白细胞计数少于1000/mm3，入院时脑脊液中蛋白含量高，全部入院患者的死亡率为30%。流行病学显示，在神经系统和全身并发症方面，60岁以下的患者与60岁及60岁以上的患者没有差异，然而，在60岁及60岁以上的死亡患者中，全身（系统）并发症是占死亡原因的59%（32/54），与此相对，在较年轻的患者中（60岁以下）神经系统并发症是占死亡原因的65%（20/31）
解释
肺炎球菌脑膜炎在成人中有较高的致死率与发病率。与神经系统并发症是较年轻患者的死因不同，较年长的患者主要死于系统并发症。
Martijn Weisfelt MDa, Diederik van de Beek MDa, Lodewijk Spanjaard MDb, Johannes B Reitsma MDc and Jan de Gans MDa, ,
aDepartment of Neurology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands
bDepartment of Medical Microbiology, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands
cDepartment of Clinical Epidemiology and Biostatistics, Centre of Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, 1100 DD Amsterdam, Netherlands
The Lancet Neurology, Volume 5, Issue 2, February 2006
Summary
Background
Bacterial meningitis is a grave disease of high incidence, especially in less developed countries. Here, we describe its clinical presentation, spectrum of complications, prognostic factors, and outcome in adults with pneumococcal meningitis.
Methods
From October, 1998, to April, 2002, we assessed 352 episodes of community-acquired pneumococcal meningitis, confirmed by culture of cerebrospinal fluid (CSF), which occurred in patients older than 16 years. Predictors for an unfavourable outcome (Glasgow outcome scale score 1–4) were identified by logistic regression with multiple imputation techniques.
Findings
245 (70%) episodes of pneumococcal meningitis were associated with an underlying disorder. Cranial CT was done for 85% of episodes and revealed underlying disorders in 17% (50/299) and meningitis-associated intracranial complications in 39% (117/299). Independent predictors for an unfavourable outcome were a low score on the Glasgow coma scale, cranial nerve palsies, a raised erythrocyte sedimentation rate, a CSF leucocyte count less than 1000 cells per mm3, and a high CSF protein concentration on admission. Overall in-hospital mortality was 30%. Prevalence of neurological and systemic complications did not differ between patients aged younger than 60 years and those aged 60 years and older; however, systemic complications were the cause of death in 59% (32/54) of fatal episodes in patients aged 60 years and older, whereas neurological complications were the cause of death in 65% (20/31) of fatal episodes in younger patients.
Interpretation
Pneumococcal meningitis is associated with high mortality and morbidity rates in adults. Whereas neurological complications are the leading cause of death in younger patients, elderly patients die predominantly from systemic complications.
成人肺炎球菌脑膜炎的临床特征、并发症和结局：前瞻性病例系列
摘要
背景
细菌性脑膜炎是有很高的发病率的严重疾病，尤其是在不发达国家。这里，我们描述成人肺炎球菌脑膜炎的临床特征、并发症的种类、影响预后的因素和结局
方法
自1998年10月至2002年4月，我们评估了352例发生在16岁以上的患者，由脑脊液培养确诊的社区获得性肺炎球菌脑膜炎，用带有对数衰减的多重归因方法评定不良结局的预期因子（Glasgow结局评分1–4）。
发现（结论？）
245例（70%）的肺炎球菌脑膜炎与潜在疾病有关，85%的患者行头CT检查，其中17%显示出有潜在的疾病（50/299），有39%的患者显示有脑膜炎相关的颅内并发症（117/299）。不良预后的独立因素是Glasgow昏迷评分低，颅神经瘫痪，ESR升高，脑脊液中白细胞计数少于1000/mm3，入院时脑脊液中蛋白含量高，全部入院患者的死亡率为30%。流行病学显示，在神经系统和全身并发症方面，60岁以下的患者与60岁及60岁以上的患者没有差异，然而，在60岁及60岁以上的死亡患者中，全身（系统）并发症是占死亡原因的59%（32/54），与此相对，在较年轻的患者中（60岁以下）神经系统并发症是占死亡原因的65%（20/31）
解释
肺炎球菌脑膜炎在成人中有较高的致死率与发病率。与神经系统并发症是较年轻患者的死因不同，较年长的患者主要死于系统并发症。
作者: WHOEVER006 编译
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