新生儿不同病原菌化脓性脑膜炎在磁共振影像学上的特点

张静; 毛健; 李娟; 陈丹

PDF(1727 KB)

中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (07) : 489-495.

论著·临床研究

新生儿不同病原菌化脓性脑膜炎在磁共振影像学上的特点

张静，毛健，李娟，陈丹

作者信息 +

MRI findings of neonatal purulent meningitis caused by different pathogenic bacteria

ZHANG Jing, MAO Jian, LI Juan, CHEN Dan

Author information +

文章历史 +

摘要

目的：探讨不同病原菌感染的新生儿化脓性脑膜炎（简称化脑）患儿的头颅磁共振（MRI）成像特点。方法：回顾性分析2005年1月到2012年2月住院治疗并行头颅MRI检查的58例新生儿化脑患儿的临床资料，对其病原体及影像学表现进行分析。结果：58例新生儿化脑患儿中首次头颅MRI检查出现神经系统并发症的有44例，发生率76%。革兰阴性菌感染以大肠杆菌感染最常见（6例），其头颅MRI表现为脑室膜炎4例，硬膜下积液1例，脑梗死1例；革兰阳性菌感染以李斯特菌居多（3例），头颅MRI均表现为不同程度的脑白质损伤。结论：不同病原体感染化脑的MRI成像表现不同，提示不同病原体感染化脑在MRI上的表现特点有助于临床诊断及治疗。

Abstract

OBJECTIVE: To study the image characteristics of neonatal purulent meningitis caused by different pathogenic bacteria, using conventional magnetic resonance imaging (MRI). METHODS: The clinical data of 58 hospitalized newborns with purulent meningitis receiving MRI examination from January 2005 to February 2012 were retrospectively studied. Pathogens and MRI findings were investigated. RESULTS: Of the 58 newborns, 44 (76%) showed complications of the neural system on the first MRI. Escherichia coli were found as the most common pathogen in newborns with Gram-negative bacteria-induced purulent meningitis (six cases). Of the six cases, four presented with ventriculitis, one with subdural effusion and one with brain infarction on MRI. Listeria monocytogenes was frequently seen in newborns with Gram-positive bacteria-induced purulent meningitis (three cases). All three cases presented with different degrees of white matter damage on MRI. CONCLUSIONS: Neonatal purulent meningitis caused by different pathogenic bacteria has different image characteristics. This suggests that understanding the patterns of MRI findings is useful in the clinical diagnosis and treatment of neonatal purulent meningitis caused by different pathogens.

导出引用

张静，毛健，李娟，陈丹. 新生儿不同病原菌化脓性脑膜炎在磁共振影像学上的特点[J]. 中国当代儿科杂志. 2012, 14(07): 489-495

ZHANG Jing, MAO Jian, LI Juan, CHEN Dan. MRI findings of neonatal purulent meningitis caused by different pathogenic bacteria[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(07): 489-495

中图分类号： R722.13

参考文献

［1］ Heath PT, Nik Yusoff NK, Baker CJ. Neonatal meningitis［J］. Arch Dis Child Fetal Neonatal Ed, 2003, 88(3):F173-F178.

［2］Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies［J］. Pediatr Infect Dis J, 2009, 28(1 Suppl): S3-S9.

［3］Bentlin MR, Ferreira GL, Rugolo LM, Silva GH, Mondelli AL, Rugolo Junior A. Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center［J］. Arq Neuropsiquiatr, 2010, 68(6): 882-887.

［4］Garges HP, Moody MA, Cotten CM, Smith PB, Tiffany KF, Lenfestey R, et al. Neonatal meningitis: What is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters?［J］.J Pediatr, 2006, 117(4): 1094-1100.

［5］Smith PB, Garges HP, Cotton CM, Walsh TJ, Clark RH, Benjamin DK Jr. Meningitis in preterm neonates: importance of cerebrospinal fluid parameters［J］. Am J Perinatol, 2008, 25(7): 421-426.

［6］Hunter JV, Moryiss MC. Neuroimaging of central nervous system infections［J］. Semin Pediatr Infec Dis, 2003, 14(2): 140-164.

［7］Jaremko JL, Moon AS, Kumbla S. Patterns of complications of neonatal and infant meningitis on MRI by organism: a 10 year review［J］. Eur J Radiol, 2011, 80(3) :821-827.

［8］Barkovich AJ著；肖江喜，袁新宇译.儿科神经影像学［M］. 第4版. 北京：中国科学技术出版社，2009:606.

［9］May M, Daley AJ, Donath S, Isaacs D; Australasian Study Group for Neonatal Infections. Early onset neonatal meningitis in Australia and New Zealand, 1992-2002［J］. Arch Dis Child Fetal Neonatal Ed, 2005, 90(4): F324-F327.

［10］Volpe JJ. Bacterial and fungal intracranial infections［M］//Volpe JJ. Neurology of The Newborn. 4th ed. London:WB Saunders, 2001: 774-810.

［11］Polin RA, Harris MC. Neonatal bacterial meningitis［J］.Semin Neonatol, 2001, 6(2): 157-172.

［12］Zaidi AK, Thaver D, Ali SA, Khan TA. Pathogens associated with sepsis in newborns and young infants in developing countries［J］. Pediatr Infect Dis J, 2009, 28(1 Suppl): S10-S18.

［13］Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world［J］. Trop Med Int Health, 2011, 16(6): 672-679.

［14］李鸿，张玉琴，张金婷，朱近，刘晓军，王怀礼，等. 儿童细菌性脑膜炎致病菌分布和耐药性及临床特点10年变迁［J］.中华儿科杂志， 2009，47（4）：272-275.

［15］Adams-Chapman I, Stoll BJ. Neonatal infection and long-term neurodevelopmental outcome in the preterm infant［J］. Curr Opin Infec Dis, 2006, 19(3): 290-297.

［16］Shah DK, Daley AJ, Hunt RW, Volpe JJ, Inder TE. Cerebral white matter injury in the newborn following escherichia coli meningitis［J］. Eur J Paediatr Neurol, 2005, 9(1): 13-17.

［17］Malik GK, Trivedi R, Gupta A, Singh R, Prasad KN, Gupta RK. Quantitative DTI assessment of periventricular white matter changes in neonatal meningitis［J］. Brain Dev, 2008, 30(5): 334-341.

［18］Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection［J］. JAMA, 2004, 292(19): 2357-2365.

［19］Back SA, Riddle A, McClure MM. Maturation-dependent vulenrability of perinatal white matter in premature birth［J］. Stroke, 2007, 38(2 Suppl): 724-730.

［20］Barkovich AJ, Westmark KD, Bedi HS, Partridge JC, Ferriero DM, Vigneron DB. Proton spectroscopy and diffusion imaging on the first day of life after perinatal asphyxia: preliminary report［J］. AJNR Am J Neuroradiol, 2001, 22(9): 1786-1794.

［21］毛健，李娟，陈丹，张静，杜亚男，王英杰，等. 磁共振成像在早产儿白色念珠菌感染脑脓肿诊断中的意义［J］.中国当代儿科杂志, 2011, 13（8）：621-626.

［22］Han KT, Choi DS, Ryoo JW, Cho JM, Jeon KN, Bae KS, et al. Diffusion-weighted MR imaging of pyogenic intraventricular empyema［J］. Neuroradiology, 2007, 49(10): 813-818.