Clinical features and imaging examination analysis of bacterial meningitis in children
2015
Objective
To investigate the clinical features and the imaging examination changes of bacterial meningitis in children of different age groups, and to offer theoretical basis for the clinic diagnosis of bacterial meningitis.
Methods
The sick children with bacterial meningitis treated in Guangzhou Women and Children's Medical Center from January 2011 to June 2013, were recruited and divided into three groups according to the age, including newborns group, infants group and more than 1 year group.Eighty-nine cases with purulent meningitis were recruited, included 58 males and 31 females.Among them, there were 34 cases in the newborns group, 41 cases in the infants group and 14 cases in the more than 1-year group.The information on the clinical features, laboratory examination and the imaging examination were summarized and analyzed, and were compared among the 3 groups.
Results
(1)Among them, 54 cases with high fever, 44 cases with respiratory symptoms, 12 cases with alimentary tract symptoms.(2)The major neurological features included convulsions(44 cases, 49.4%), fatigue(36 cases, 40.4%), vomiting(21 cases, 23.6%), cervical rigidity(9 cases, 10.1%), fontanel full(7 cases, 7.9%), headache(6 cases, 6.7%), limb paralysis(5 cases, 5.6%). The percentage of high fever, vomiting, headache, cervical rigidity in the more than 1 year group were significantly more than those of the newborns group and the infants group(χ2=10.093, 12.063, 34.466, 7.177, all P<0.05). (3)Among them, white blood cell(WBC)accounts were from 2.20 to 60.60×109/L, the mean was (16.49±10.37)×109/L.Hypersensitive C-reaction protein concentration in blood was 4.00 to 376.53 g/L, the mean was (131.07±86.91) g/L.In cerebrospinal fluid(CSF), WBC accounts were from 1 to 21 800×106/L, the mean was (910.05±274.07)×106/L, the glucose concentration from 0.00 to 4.50 mmol/L, the mean (1.72±1.03)mmol/L, the protein concentration from 0.42 to 4.89 g/L, the mean was(1.64±1.03)g/L.In 40 cases with atypical CSF change, 23 cases with CSF glucose ratio(CSF glucose/blood glucose) less than or equal to 0.4, and 15 cases with blood cultures positive.(4)The image examination showed magnetic resonance imaging(MRI) abnormalities in 51/75 cases, computerized tomography(CT) scan abnormalities in 15/30 cases.The percentage of convulsions, the brain MRI abnormalities and the MRI display rate of bacterial meningitis in the infants group were significantly more than those of the newborns group and the more than 1 year group(χ2=11.768, 9.047, 7.674, all P<0.05). The display rate of meningitis and subdural hydroma by the brain MRI were significantly more than those of the head CT scan(χ2=7.430, 5.291, all P<0.05).
Conclusions
Because of the atypical clinical features of bacterial meningitis in newborn and infant, lumber puncture should be performed in all doubtful cases who had a fever and/or seizure.CSF glucose less than or equal to 0.4 of simultaneously obtained blood glucose value, the enhanced MRI sequence or blood cultures were useful for the likelihood of meningitis, if CSF chemistries and cytology vary atypically. The MRI sequence can significantly mostly improve the display rate of bacterial meningitis than the enhance CT.
Key words:
Bacterial meningitis; Child; Imaging alterations
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