兒童無菌性腦膜炎流行病學特徵：一區域教學醫院之報告

Epidemiological Feature of Pediatric Aseptic Meningitis - Report of A Regional Teaching Hospital

目的：無菌性腦膜炎是指腦膜發炎但腦脊髓液沒有辨識出細菌感染之臨床症狀。此研究之目的在檢視一區域教學醫院無菌性腦膜炎病童之季節分布、臨床表現、腦脊髓液變化之流行病學特徵。方法：2006年1月至2012年12月這6年之間，回顧病歷之醫療記錄來審查年齡在15歲以下患有無菌性腦膜炎的病童，收集了關於流行病學特徵、臨床表現、和實驗室檢查的數據來分析。結果：本研究一共收集了41個案例（30位男性，11位女性平均7.7歲）。大部分的病例發生於夏季。最明顯之症狀為發燒（100％）、頭痛（68%）、嘔吐（61%）。頸部僵硬可見於63%的病患。腦脊髓液之白血球數目平均為487.6±155.5 （範圍從10至3406）。腦脊髓液之白血球數目少於500佔75.61%及腦脊髓液之淋巴球顯著者（>50%）佔78.05%。大部分的病患無法證實病原，而只有5位病患偵測到病毒。研究期間沒有嚴重併發症及死亡。結論：在我們的研究顯示大部分之無菌性腦膜炎無法辨識出病原。腦脊髓液特徵可以用來幫助診斷此疾病。無菌性腦膜炎好發於夏季且其預後相當良好。

Purposes: Aseptic meningitis refers to a clinical syndrome of meningeal inflammation in which bacteria cannot be identified in the cerebrospinal fluid (CSF). This study aimed at investigating seasonal variation, clinical symptoms, and CSF changes in pediatric patients with aseptic meningitis admitted in a regional teaching hospital. Methods: During the 6-year study period (January 2006 to December 2012), pediatric patients admitted to the hospital with aseptic meningitis were reviewed retrospectively. Epidemiological characteristics, clinical presentation, and laboratory data were collected and analyzed. Results: A total of 41 children (30 males and 11 females, mean age 7.7 years) were evaluated in this study. Most of the cases occurred during summer (73.2%). The dominant clinical symptoms were fever (100%), headache (68%), and vomiting (61%). Neck stiffness was noted in 63 % of the patients. The mean CSF white blood cell (WBC) count was 487.6±155.5 cells/mm3 (range 10 to 3,406). There were 75.61% of patients had a CSF WBC count less than 500 cells/mm3 and 78.05% of patients revealed a CSF lymphocytes predominance (>50%). The causative agents of most cases were unidentified, and viruses were detected in only 5 patients. There were no serious complications or death event. Conclusions: The causative agents of aseptic meningitis were unidentified in most of patients. The CSF features were helpful to be used for diagnosis. Aseptic meningitis was found to be more frequent during the summer and its prognosis appeared to be excellent.