幼児期の細菌性髄膜炎の重症度および診断前の病気の持続時間
T Kilpi1, M Anttila, M J Kallio
1Children's Hospital, University of Helsinki, Finland.
Lancet (London, England)
|August 17, 1991
まとめ
幼児期の細菌性髄膜炎 (BM) の迅速な診断は極めて重要です. しかし,入院前のより長い病気の期間は,子供達のより良い臨床結果と相関しており,潜入的な疾患パターンが避けられない診断の遅延を引き起こす可能性があることを示唆しています.
科学分野:
- 小児科は小児科です.
- 感染症 感染症は感染症です.
- クリニカル・メディシン 臨床医学
背景:
- 幼児期細菌性髄膜炎 (BM) の迅速な診断は,好ましい結果のために不可欠と考えられています.
- 小児BMにおける入院前の病気の持続時間と疾患の重症度の関係については,さらなる調査が必要である.
研究 の 目的:
- 病院入院前の病気の持続時間と,小児期の細菌性髄膜炎の臨床的重症度の間の関連性を調査する.
主な方法:
- 展望的な研究では,フィンランドの18の小児病院 (1984年−1989年) で,培養陽性BMの286人の子供からデータを収集した.
- 症例は,短期史 (≤24h),中期史 (>24h~≤48h),長期史 (>48h) のグループに分類されました.
- 臨床的重症は,意識レベル,発作,CSFタンパク質,グラムステイン,血液培養,CRP,尿中のナトリウムを含む変数を使用して評価されました.
主要な成果:
- 病気の期間が短い (≤48時間) の子どもは,より長い病歴 (>48時間) の子どもと比較して,著しく悪化した臨床状態を示しました.
- 意識,発作,CSFのタンパク質,CSFのプラスのグラムステイン,プラスの血液培養 (H. influenzae),血清のCRP,尿のナトリウムに関して,より悪い結果が観察されました.
- これらの差異は,病原体,性別,年齢,または以前の抗菌剤使用とは無関係でした.
結論:
- 小児性細菌性髄膜炎の入院前のより長い病期は,逆説的に,より良い臨床状態と関連しています.
- BMの潜伏的な発症は,避けられない診断の遅延につながり,医療法的な影響を及ぼす可能性があります.
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