摘要
Salmonella所引起之腦膜炎在文獻上誠屬少見。此種化膿性腦炎大部發生於六個月以下的嬰孩，且死亡率很高。最近馬偕醫院小兒科曾體驗到三例Salmonella腦膜炎，其中二例由Salmonella Typhosa所引起，一例由Salmonella Paratyphoid B所引起，他們的年齡各爲五個月、四個月及四個月大。 這種腦膜炎之診斷是基於脊髓液各有二次以上培養出上述細菌及脊髓液生化及常規檢查所得。 我們發現此三例有幾個特點。第一、他們來院時都沒有下痢，第二、他們來院時症狀及體檢所見，如發燒、焦躁不安、嗜睡、前窗突起等等，無不顯示有腦膜發炎現象，第三、腦膜炎臨床症狀及脊髓液變化，雖然給予適當治療恢復很慢。第四、雖曾多次試驗Widal test但皆陰性，第五、他們發病時其同僚或兄弟姊妹皆患有下痢，然而，他們的兄弟姊妹和母親之大便培養及採血做Widal test皆正常。第六、他們來院時肝脾皆沒有腫大，沒有Rose spot疹出現。他們白血球數不高。 第一例經治療約二個星期後，臨床上及脊髓液檢查已近痊癒。雖繼給口服抗生素但一星期後病復發死亡。第二例經治療後第十一天出現Subdural effusion，七次Subdural tap經硬膜下穿刺，抽出一百六十八西西Subdural fluid。第三例經治療後雖然脊髓液檢查結果逐漸轉好，但意識濁鈍，病後三個月檢查時已可見到發育遲緩及對外來反應遲鈍。 因見於會復發加上臨床及脊髓液恢復正常很慢，我們主張患有Salmonella腦膜炎小孩，比一般腦膜炎應給予够長時間之治療。所用抗生素以Ampicillin爲主可加Chloromycetin及Garamycin合用。 文中曾討論到Widal test呈陰性之理由。
關鍵字
無資料並列摘要
We have experienced three cases of Salmonella meningitis in this hospital in the past half year. All of them are boys and their age are 5 months, 4 months and 4 months respectively. They presented with clinical symptoms, signs and physical findings suggestive of C. N. S. infection. Meningitis was confirmed by positive C. S. F. culture. Case 1 and 2 were due to infection by Salmonella Typhosa. In case 3 it grew Salmonella Paratyphoid B. We found that none of our patients had diarrhea when they entered the hospital. In addition lack of splenomegaly, rose spots and relative bradycardia was conspicuous. We are surprised at negative Widal test in our patients, even blood samples at different stages of illness were sent. The possible explanation for failure in developing appreciable agglulinin response has been discussed. Ampicillin and/or chloromycetin are drugs of choice for treatment of Salmonella meningitis. Although these are sensitive antibiotics, we are quite surprised at their slow recovery. Because of this and possible relapse may occur, we wish to emphasiae that in care of Salmonella meningitis adequate antibiotics should be used long enough to ensure bacteriological and clinical recovery. Mortality of Salmonella meningitis is high. In case one he died of relapse one week after discharge. In case two subdural effusion was noted on the 11th hospital day and it required 7 subdural taps. In case three, when followed up 3 months later, slow psycho-motor development and possible hydrocephalus were demonstrated.
並列關鍵字
無資料延伸閱讀
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