PDF(Pubmed)
Abstract：
Bacterial meningitis is still a significant public health concern, with high morbidity and mortality rates. Despite this, it is still a rare event that requires the bacterial invasion of the meninges. However, some predisposing factors can trigger recurrent episodes of meningitis. This study is aimed at determining the clinical characteristics and the molecular epidemiology of episodes of recurrent community-acquired meningitis with and without predisposing factors. For this purpose, we performed a retrospective study of our laboratory database during the period of 2010 to 2020. Additionally, using molecular tools developed in our previous works, the epidemiology of the pathogens causing these episodes was analyzed using cerebrospinal fluid samples, especially in the absence of isolated strains. We observed a total of 1,779 meningitis cases and 230 were caused by Streptococcus pneumoniae. Of those, 16 were recurrent meningitis episodes (16/1,779; 0.9%) from seven patients. Pneumococcus was the main agent responsible in these recurrent episodes and only two episodes were caused by Haemophilus influenzae. The mean age of these patients was 20 years old and three had predisposing factors which could have led to contracting meningitis. The samples presented different pneumococcal serotypes. Most of them were non-vaccine-covered serotypes and antibiotic susceptible strains. Therefore, it was demonstrated how the practical employment of molecular tools, developed for research, when applied in the routine of diagnosis, can provide important information for epidemiological surveillance. Furthermore, it was shown how pneumococcus was the leading cause of recurrent community-acquired meningitis without predisposing factors, suggesting that pneumococcal vaccination may be necessary, even in those groups of individuals considered to be less susceptible.
摘要：
细菌性脑膜炎仍然是一个重大的公共卫生问题，高发病率和死亡率。尽管如此,它仍然是一个罕见的事件，需要细菌入侵的脑膜。然而,一些诱发因素可引发脑膜炎反复发作.这项研究旨在确定有或没有诱发因素的复发性社区获得性脑膜炎的临床特征和分子流行病学。为此,我们在2010年至2020年期间对实验室数据库进行了回顾性研究.此外,使用我们以前工作中开发的分子工具，使用脑脊液样本分析了导致这些发作的病原体的流行病学，特别是在没有分离菌株的情况下。我们共观察到1,779例脑膜炎病例，其中230例是由肺炎链球菌引起的。其中,7例患者中有16例复发性脑膜炎发作（16/1,779；0.9％）。肺炎球菌是这些反复发作的主要原因，只有两次发作是由流感嗜血杆菌引起的。这些患者的平均年龄为20岁，其中三人具有可能导致感染脑膜炎的诱发因素。样品呈现不同的肺炎球菌血清型。其中大多数是非疫苗覆盖的血清型和抗生素敏感菌株。因此,它证明了分子工具的实际应用，为研究而开发，当应用于常规诊断时，可以为流行病学监测提供重要信息。此外，研究表明，肺炎球菌是导致社区获得性脑膜炎复发的主要原因，而没有诱发因素，提示肺炎球菌疫苗可能是必要的，即使在那些被认为不太容易受到影响的人群中。
