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目的了解细菌性脑膜炎发病、流行病学及病原学特征的变化趋势,为制定针对性的防控措施提供科学依据。方法 2007-2012年在广西贵港市及所辖市、县建立起以实验室检测为基础的脑膜炎症状监测系统。对符合筛检标准的病例进行流行病学调查,并采集脑脊液及血标本进行常规检查、细菌培养及聚合酶链反应(polymerase chain reaction,PCR)检测。结果共评估了2 493名病例,其中实验室确诊病例95例,临床诊断444例,可疑病例1 954例。确诊及临床诊断的细菌性脑膜炎年均发病率为2.63/10万;死亡21例,病死率为3.90%。发病年龄呈增高趋势,确诊及临床诊断病例年龄中位数为17岁。由真菌引起的感染增多,脑脊液及血培养阳性菌中新型隐球菌分别占42.55%(20/47)及16.36%(9/55);其次为猪链球菌,分别占14.89%(7/47)及7.27%(4/55)。用PCR方法检出脑膜炎奈瑟菌2株、流感嗜血杆菌2株及肺炎链球菌10株。结论细菌性脑膜炎的流行病学及病原谱发生了变化;敏感的症状监测系统加以实验室检测结果对脑膜炎的发现、防控及临床诊疗有较重要的意义。
Objective To understand the trend of the epidemic, epidemiology and etiology of bacterial meningitis and provide a scientific basis for the development of targeted prevention and control measures. Methods From 2007 to 2012, a monitoring system based on laboratory tests for meningitis was established in Guigang, Guangxi and its cities and counties. Epidemiological investigation was performed on cases meeting the screening criteria. Cerebrospinal fluid and blood samples were collected for routine examination, bacterial culture and polymerase chain reaction (PCR). Results A total of 2 493 cases were evaluated, of which 95 were diagnosed clinically, 444 clinically diagnosed, and 1 954 suspicious cases. The average annual incidence of bacterial meningitis diagnosed and clinically diagnosed was 2.63 / 100 000; 21 died and the case fatality rate was 3.90%. The age of onset showed an increasing trend. The median age of confirmed and clinically diagnosed cases was 17 years. Infections caused by fungi increased, Cryptococcus neoformans accounted for 42.55% (20/47) and 16.36% (9/55) in cerebrospinal fluid and blood culture positive bacteria respectively, followed by Streptococcus suis, accounting for 14.89% (7/47) And 7.27% (4/55) respectively. Two strains of Neisseria meningitidis, two strains of Haemophilus influenzae and 10 strains of Streptococcus pneumoniae were detected by PCR method. Conclusions The epidemiology and pathogenic spectrum of bacterial meningitis have changed. The results of laboratory tests of sensitive symptom monitoring system are of great significance for the detection, prevention and treatment of meningitis and clinical diagnosis and treatment.