背景:A组链球菌(GAS)脑膜炎是一种严重的疾病,病死率高。在GAS脑膜炎增加的时代,我们对这种疾病的了解是有限的。
目的:为了更好地了解GAS脑膜炎。
方法:报告5例新的GAS脑膜炎病例。检索PUBMED和EMBASE相关文献进行系统评价。包括病例报告和儿科病例系列。人口统计信息,危险因素,症状,治疗,结果,并对GAS的EMM类型进行了总结。
结果:共263例。在100个人中,9.9%(8/81)既往有水痘,11.1%(9/81)有解剖因素,53.2%(42/79)有颅外感染。软组织感染在婴儿中常见(10/29,34.5%),而耳/鼻窦感染在≥3岁儿童中更为普遍(21/42,50.0%)。总病死率(CFR)为16.2%(12/74)。在有休克或全身并发症的患者中发现高死亡风险,幼儿(<3岁)与血源性传播有关。死亡的主要原因是休克(6/8)。在纳入病例系列研究的163名患者中,耳/鼻窦感染范围为21.4%至62.5%,而STSS/休克范围为12.5%至35.7%,CFR范围为5.9%至42.9%。
结论:有水痘病史,软组织感染,脑膜旁感染和脑脊液漏是脑膜炎患儿GAS的重要临床线索。由于死亡风险高,幼儿和血源性传播相关病例需要密切监测休克。
BACKGROUND: Group A streptococcal(GAS) meningitis is a severe disease with a high
case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited.
OBJECTIVE: To gain a better understanding about GAS meningitis.
METHODS: Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE.
Case reports and
case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized.
RESULTS: Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall
case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in
case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%.
CONCLUSIONS: A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.