학술논문
2007—2016年济南市流行性脑脊髓膜炎实验室确诊病例的流行病学和临床特征分析 / Analysis of current epidemiological and clinical characteristics for laboratory confirmed epidemic cerebrospinal meningitis cases in Shandong Province, 2007-2016
Document Type
Academic Journal
Author
张岩; 宋立志; 刘桂芳; 李漫时; 林小娟; 徐爱强; Zhang Yan; Song Lizhi; Liu Guifang; Li Manshi; Lin Xiaojuan; Xu Aiqiang
Source
中华预防医学杂志 / Chinese Journal of Preventive Medicine. 53(2):169-173
Subject
Language
Chinese
ISSN
0253-9624
Abstract
目的 分析济南市流行性脑脊髓膜炎(流脑)实验室确诊病例的流行病学和临床特征.方法 收集2007—2016年济南市6家急性脑膜炎脑炎症候群(AMES)哨点监测医院上报的AMES病例的个案调查资料、临床信息,并采集病例血清和(或)脑脊液标本.采用Real?time PCR、细菌培养等方法进行脑膜炎奈瑟菌(Nm)的检测及其血清群鉴定,描述流脑实验室确诊病例的流行病学和临床特征.结果 2007—2016年,6所哨点医院共报告AMES病例6 809例,共检测病例标本4 422份,发现实验室确诊流脑病例90例,其中Real?time PCR、血培养和脑脊液培养方法分别确诊90、2和1例.2007—2011年确诊流脑22例(其中4例未分群),以Nm C群为主(17/18),不可分群1例(1/18);2012—2016年确诊流脑病例大幅增多(68例,其中1例未分群),以Nm B群为主(43/67,64.2%),C群则大幅降低(5/67,7.5%),首次检出W135群(2012年和2013年各2例)和X群(2014年1例)病例,不可分群病例也有所升高(13/67,19.4%);而Nm A群一直处于低流行状态,仅在2013年发现1例.流脑全年均有发病,但以冬春季节居多,当年11月至次年5月流脑确诊病例占AMES检测病例的比例(3.5%,67/1 920)高于6至10月(0.9%,23/2 502)(χ2=34.45,P<0.001).病例以儿童、学生和农民为主,分别占30.0%(27/90)、31.1%(28/90)、18.9%(17/90);<20岁者居多,占66.7%(60/90),其中感染Nm C群者以>12岁为主(77.3%,17/22),而B群(55.8%,24/43)和不可分群病例(6/14)在≤12岁者中比例较高.流脑病例的主要临床症状为发热(78/90,86.7%)、头痛(59/90,65.6%)和呕吐(51/90,56.7%),且因其特异性症状、血液和脑脊液阳性指征不典型,导致入院诊断误诊率高达87.8%(79/90);而诊断正确流脑病例痊愈的比例为7/11,高于诊断错误者(2.5%,2/79)(χ2=40.61,P<0.001).结论 流脑病例的临床症状不典型,加强分子生物学检测可提高诊断的灵敏性和准确性.Nm优势致病血清群发生由C群向B群的变迁,流脑菌群变异趋势监测是防控工作的重点.
Objective To analyze epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases. Methods Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of AMES (acute meningitis/ encephalitis syndrome) cases were collected in the six sentinel hospitals from 2007 to 2016. neisseria meningitides ( Nm ) species and serogroup identification were detected by the methods of real?time fluorescent quantitative polymerase chain reaction (Real?time PCR) and bacterial culture, and epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases were analyzed. Results 6 809 AMES cases were reported from 2007 to 2016. Total 4 422 cases were detected, and 90 cases were Nm positive. Through the methods of Real?time PCR, bacterial blood culture and CSF culture, the numbers of Nm positive cases were 90, 2 and 1 respectively. Twenty?two Nm cases were identified from 2007 to 2011 (4 cases were ungrouped), which with the highest incidence in serogroup C cases (17/18), and one cases was ungroupable Nm . Nm laboratory confirmed cases (68 cases) were increased dramatically and mainly occurred in serogroup B cases (43/67, 64.2%) from 2012 to 2016, with serogroup C cases highly decreased (5/67, 7.5%) and ungroupable Nm cases increased (13/67, 19.4%) meanwhile. Serogroup W135 and X cases were first detected at 2012 and 2014, and serogroup A remaining a low level which only detected one case at 2013. The morbidity of epidemic cerebrospinal meningitis was occured in the whole year, and mainly in winter and spring. The ratio of Nm laboratory confirmed cases to AMES cases during November to May (3.5%, 67/1 920) was higher than that during June to October (0.9%, 23/2 502) (χ2=34.45, P<0.001). Most Nm cases were children, students and farmers, and account for 30.0% (27/90), 31.1% (28/90), 18.9% (17/90), respectively. The majority of Nm cases were under 20 years old (60/90, 66.67%), and serogroup C cases (17/22, 77.3%) mainly occurred in over 12 years old population, while serogroup B (24/43, 55.8%) and ungroupable (6/14) cases mainly occurred in under 12 years old population. The main clinical symptoms of epidemic cerebrospinal meningitis cases were fever (78/90, 86.7%), headache (59/90, 65.6%) and vomiting (51/90, 56.7%). Misdiagnosis rate of admitting diagnosis was up to 87.8% (79/90) for the reason of atypical features in specific symptoms and blood or CSF positive index. The well?healed ratio in correct diagnosed group (7/11) was higher than that in misdiagnosed group (2.5%, 2/79) (χ2=40.61, P<0.001). Conclusion The clinical symptoms of epidemic cerebrospinal meningitis cases were atypical, and the diagnosed sensitivity and accuracy would be improved by enhanced molecular biology detection. The predominant epidemic serogroup of Nm switched from serogroup C to B, and the key work was surveaylance of serogroup transition.
Objective To analyze epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases. Methods Epidemiological and clinical informations and cerebrospinal fluid (CSF) and blood specimens of AMES (acute meningitis/ encephalitis syndrome) cases were collected in the six sentinel hospitals from 2007 to 2016. neisseria meningitides ( Nm ) species and serogroup identification were detected by the methods of real?time fluorescent quantitative polymerase chain reaction (Real?time PCR) and bacterial culture, and epidemiological and clinical characteristics of laboratory confirmed epidemic cerebrospinal meningitis cases were analyzed. Results 6 809 AMES cases were reported from 2007 to 2016. Total 4 422 cases were detected, and 90 cases were Nm positive. Through the methods of Real?time PCR, bacterial blood culture and CSF culture, the numbers of Nm positive cases were 90, 2 and 1 respectively. Twenty?two Nm cases were identified from 2007 to 2011 (4 cases were ungrouped), which with the highest incidence in serogroup C cases (17/18), and one cases was ungroupable Nm . Nm laboratory confirmed cases (68 cases) were increased dramatically and mainly occurred in serogroup B cases (43/67, 64.2%) from 2012 to 2016, with serogroup C cases highly decreased (5/67, 7.5%) and ungroupable Nm cases increased (13/67, 19.4%) meanwhile. Serogroup W135 and X cases were first detected at 2012 and 2014, and serogroup A remaining a low level which only detected one case at 2013. The morbidity of epidemic cerebrospinal meningitis was occured in the whole year, and mainly in winter and spring. The ratio of Nm laboratory confirmed cases to AMES cases during November to May (3.5%, 67/1 920) was higher than that during June to October (0.9%, 23/2 502) (χ2=34.45, P<0.001). Most Nm cases were children, students and farmers, and account for 30.0% (27/90), 31.1% (28/90), 18.9% (17/90), respectively. The majority of Nm cases were under 20 years old (60/90, 66.67%), and serogroup C cases (17/22, 77.3%) mainly occurred in over 12 years old population, while serogroup B (24/43, 55.8%) and ungroupable (6/14) cases mainly occurred in under 12 years old population. The main clinical symptoms of epidemic cerebrospinal meningitis cases were fever (78/90, 86.7%), headache (59/90, 65.6%) and vomiting (51/90, 56.7%). Misdiagnosis rate of admitting diagnosis was up to 87.8% (79/90) for the reason of atypical features in specific symptoms and blood or CSF positive index. The well?healed ratio in correct diagnosed group (7/11) was higher than that in misdiagnosed group (2.5%, 2/79) (χ2=40.61, P<0.001). Conclusion The clinical symptoms of epidemic cerebrospinal meningitis cases were atypical, and the diagnosed sensitivity and accuracy would be improved by enhanced molecular biology detection. The predominant epidemic serogroup of Nm switched from serogroup C to B, and the key work was surveaylance of serogroup transition.