The Study Of Clinical And Pathogenic Analysis And The Value Of S100B In Early Diagnosis Of Pediatric Bacterial Meningitis

Part oneClinical and pathogenic analysis of bacterial meningitis in childrenObjective:To analyze the clinical characteristics and etiology diagnosis in bacterial meningitis from2001to2012in Children’s Hospital of Fudan University.Methods:Clinical data, including the clinical symptoms, signs, laboratory test, imaging examination, complications, outcomes, etiology and antibiotics-resistance were analyzed retrospectively based on the hospitalized children with bacterial meningitis during12years. These pathogens were identified in all cases.Results:1.146pathogen-identified cases from570pediatric patients with bacterial meningitis in the last12years were analyzed in this study.2. These cases were classified into four groups:58neonates,36patients aged28d-ly,20patients aged1-3y and32patients aged>3y. The clinical manifestations depend on the age. The symptoms of neonates were atypical. The proportion of complications in infants was higher than that in other groups (χ2=11.891, P<0.05). Vomiting and signs of meningitis irritation were common in children over1year old.18patients (50%) older than3y were associated with traumatic brain injury, tumor and craniofacial or spinal abnormal anatomy.3. During2001-2012, the average positive rate of cerebrospinal fluid culture in our hospital was25.6%, of which G+account for54.8%(80/146) and G-account for45.2%(66/146). The main G+bacteria included Coagulase negative Staphylococcus (22.6%), Enterococcus (13.0%), Streptococcus pneumonia (8.2%). The main G-bacteria included Escherichia coli (20.5%), Acinetobacter baumannii (6.8%), Neisseria meningitis (4.1%). Escherichia coli (25.9%), Coagulase negative Staphylococcus (22.4%), Enterococcus (17.2%) were the most common in neonates.4. All the G+bacteria were sensitive to vancomycin and linezolid.86%(43/50) of G+bacteria were sensitive to rifampicin. All G-bacteria were sensitive to meropenem, except3of10cases with Acinetobacter baumannii and1of3cases with Pseudomonas aeruginosa strains. The proportion of ESBLs+in Escherichia coli, Klebsiella and Enterobacter cloacae were66.7%,60%and100%.5. There were relationship between the pathogenic bacteria and the acute complications and the prognosis. There were43.2%(63/146) cases with acute complications. The most common complications included subdural effusion, hydrocephalus and focal neurological lesion. The main pathogens were Escherichia coli, Coagulase negative Staphylococcus, Streptococcus pneumonia and Acinetobacter baumannii.31patients (21.2%) died or gave up treatment because of poor prognosis, of which6cases (4.1%) died.41.7%(5/12) of bacterial meningitis with Streptococcus pneumonia died or gave up the treatment.Conclusion:The clinical features depend on the patients’age. The signs and symptoms were atypical in neonates and infants. Anatomy abnormalities should be paid more attention to in children older than3y. Coagulase negative Staphylococcus, Escherichia coli, Enterococcus and Streptococcus pneumonia were more common in our cases. Vancomycin, linezolid and meropenem were most effective medicine. Subdural effusion, hydrocephalus, focal neurological lesion were the common acute complications, especially more common in the infection of Escherichia coli, Coagulase negative Staphylococcus, Streptococcus pneumonia, and Acinetobacter baumannii. The meningitis patients with Streptococcus pneumonia had poor prognosis.Part twoThe value of S100B in early diagnosis of bacterial meningitisObjective:To analyze the value of S100B in early diagnosis of bacterial meningitis, the cerebrospinal fluid (CSF)-serum-pairs S100B levels of pediatric patients with central nervous system infection and continual CSF S100B levels of patients with bacterial meningitis were measured and compared with the routine laboratory parameters.Methods:S100B levels in cerebrospinal fluid and serum were measured in three groups:patients with bacterial, viral central nervous system infections and patients who underwent lumbar puncture to exclude infectious central nervous system diseases. The cut-off value, classification accuracy, sensitivity and specificity of S100B and routine parameters (CSF protein, glucose, leukocyte count, serum CRP) were studied by receiver operating characteristic (ROC) curves.Results:1. A total of132pediatric patients with CSF-serum-pairs specimen were enrolled. There were91cases in acute stage, including23cases with bacterial meningitis,24cases with viral encephalitis/meningoencephalitis and44cases as controls. The other41cases were in recovery stage, including28cases with bacterial meningitis and13cases with viral encephalitis/meningoencephalitis. The sequential detections of S100B in CSF were practiced in8patients with bacterial meningitis by repetitive lumbar puncture more than3times.2. The CSF S100B levels in acute stage in bacterial and viral central nervous system infection group were772.61±71.98pg/ml and449.48±44.85pg/ml, both of which were higher than that in control group (225.42±13.72pg/ml). The levels were higher in bacterial than in viral infection (t=3.845, P<0.001). The area under the curve (AUC) for the early diagnosis of bacterial meningitis was0.93(95%CI,0.87～0.98).The optimal S100B cut-off value in CSF was423.89pg/ml with0.91sensitivity (95%CI,0.73～0.98) and0.82specificity (95%CI,0.72-0.90).3. The serum S100B levels in acute stage in patients with bacterial meningitis were423.56±73.84pg/ml, which were significantly higher than those in viral encephalitis/meningoencephalitis (t’=4.287, P<0.001) and controls (t’=4.139, P<0.001). No significant difference was found between patients with viral infection and controls. The AUC for the diagnosis of bacterial meningitis was0.90(95%CI,0.83-0.96). The optimal S100B cut-off value in serum was135.91pg/ml with0.96sensitivity (95%CI,0.79～0.99) and0.76specificity (95CI,0.65～0.85).4. The serum levels of S100B were associated with the cerebrospinal fluid in patients with acute bacterial meningitis. Compared with the early diagnosis of S100B levels in CSF, the compliance rate of that in serum was79.1%(Kappa value=0.563, P<0.001).5. Higher S100B levels in bacterial meningitis were found on admission and showed a decrease afterwards. The serum S100B levels in patients with acute complications (605.79+129.39pg/ml) were higher (t’=2.576, P<0.05).Conclusions:The S100B level is a predictor for early diagnosis of bacterial meningitis, and the optimal S100B cut-off values were423.89pg/ml in CSF and135.91pg/ml in serum. The serum S100B level is also a useful parameter in prognosis prediction, especially when lumbar punctures are undesired or contraindicated. The dynamic change of S100B might be used as a monitoring parameter to predict the prognosis of bacterial meningitis.