新生兒黃質菌腦膜炎的臨床觀察

Clinical Observation of Neonatal Meningitis Caused by Flavobacterium Meningosepticum

林姃慧(Cheng-Huei Lin) ； 黃富源(Fu-Yuan Huang)

《Acta Paediatrica Sinica》 32卷3期 (1991/06) Pp. 171-176

https://doi.org/10.7097/APS.199106.0171

摘要

馬偕醫院小兒科從民國70年1月至77年12月共經歷了11例黃質菌(Flavobacterium meningosepticum)引起的新生兒腦膜炎。男嬰6人，女嬰5人。早產及體重過輕者7人。發病年齡自3天大至20天大不等。有7例屬於院內感染。臨床症狀以活動力不佳最多，發紺、抽搐、發燒次之。呼吸暫停、腹脹、嘔吐、黃疸、前囪門膨出較少見。脊髓液檢查：9例出現白血球升高、蛋白質升高、醣分下降。抗生素敏感試驗顯示，此菌對於常用的ampicillin，aminoglycosides及第一、二、三代cephalosporins大多具抗藥性，而對piperacillin則全部具感受性。11例中，前面5例以常規治療新生兒腦膜炎之抗生素（ampicillin合併aminoglycosides或第三代cephalosporin）治療5到18天不等。結果有3例死亡（其中二例出現水腦），2例自動出院。後面6例以piperaciliin治療三星期，其中三例併用vancomycin。除了1例曾出現水腦，後來併發敗血症死亡外，其餘5例皆存活；其中3例出現水腦有2例做了分流手術。另2例無水腦，出院時均正常。由黃質菌引起的新生兒腦膜炎在新生兒腦膜炎中是少見的，一般都由院內感染引起，有高死亡率及後遺症。早期使用具感受性之抗生素，注意水腦發生，必要之分流手術，可以減少後遺症及死亡率。

並列摘要

Clinical Observation of Neonatal Meningitis Caused by Flavobacterium Meningosepticum
From January 1981 to December 1988, we collected 11 cases of neonatal meningitis caused by Flavobacterium meningosepticum. The 6 male and 5 female newborns ranged from 3 days to 20 days old. Birth body weight varied from 1100 gm to 3600 gm. Seven cases were premature or small for date. Nosocomial infection was noted in 7 of these 11 cases.
Clinically, lethargy and poor activity were the most common symptoms. Cyanosis, fever and convulsion were the next. There were 9 cases showing pleocytosis, increased protein and decreased glucose level in the cerebrospinal fluid examination. The organisms isolated in all 11 cases were susceptible to piperacillin, resistant to ampicillin, aminoglycosides and cephalosporin.
Five patients were treated with antibibiotics other than piperacillin for 5 to 18 days. Three patients died; hydrocephalus was the cause of death in 2 of them. Two patients were discharged against advice.
Among the remaining 6 cases we gave piperacillin for 3 weeks, one case devloped hydrocephalus but eventually succumbed to K. pneumoniae sepsis. Out of five surviving cases, 3 developed hydrocephalus (VP shunt performed in two). The other two patients were discharged without neurological deficit.
In conclusion, neonatal Flavobacterium meningosepticum meningitis was more frequent in premature or small for date babies, and it usually appeared in nosocomial infection. The prognosis was poor and piperacillin was proved to be the drug of choice.

並列關鍵字

Flavobacterium meningosepticum ； neonatal meningitis ； piperacillin