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Community-acquired Bacterial Meningitis in Adults With Cerebrospinal Fluid Leakage

Liora ter Horst, Matthijs C. Brouwer, Arie van der Ende, and Diederik van de Beek
Liora ter Horst、 Matthijs C. Brouwer、 Arie van der Ende 和 Diederik van de Beek
'Department of Neurology, Amsterdam Neuroscience, Department of Medical Microbiology, Amsterdam Infection and Immunity, and Netherlands Reference Laboratory for Bacterial Meningitis,
'阿姆斯特丹神经科学神经病学系、 阿姆斯特丹感染与免疫医学微生物学系和 荷兰细菌性脑膜炎参考实验室,
Amsterdam University Medical Centers, University of Amsterdam, The Netherlands

Background. Cerebrospinal fluid (CSF) leakage is a risk factor for developing bacterial meningitis.
背景。脑脊液 (CSF) 渗漏是发生细菌性脑膜炎的危险因素。
Methods. We analyzed episodes of community-acquired bacterial meningitis associated with CSF leakage from a prospective nationwide cohort study.
Results. CSF leakage was identified in 65 episodes of 2022 episodes ( ) in 53 patients. The cause of CSF leakage was identified in 49 of 65 episodes ( ), which most commonly consisted of ear-nose-throat surgery ( 19 of 49 episodes [29%]) and remote head trauma ( 15 of 49 episodes [23%]). The episode was a recurrent meningitis episode in 38 patients ( ). Of the recurrent episodes, 27 had known CSF leakage ( ) of whom had previous surgery aiming to close the leak Nine patients ( ) with known CSF leakage had been vaccinated ( 23 -valent pneumococcal vaccine in 9 patients, meningococcal serogroup vaccine in 2 , meningococcal serogroup A and Haemophilus influenzae type b vaccine each in 1 patient). Streptococcus pneumoniae was cultured in 33 episodes ( ) and H. influenzae in 11 episodes ( ). The most common pneumococcal serotypes were 3 ( 4 episodes), 35B, , 38, and 15C (each 2 episodes). Haemophilus influenzae was unencapsulated in all 10 episodes with known capsule type. The outcome was unfavorable in 8 episodes ( ) and no patient died.
结果。在 53 例患者的 2022 年发作的 65 次发作中发现了脑脊液渗漏 ( )。脑脊液渗漏的原因在 65 例发作中的 49 例中被确定 ( ),最常见的包括耳鼻喉手术(49 例中的 19 例 [29%])和远程头部外伤(49 例中的 15 例 [23%])。该事件是 38 例患者的复发性脑膜炎发作 ( )。在复发发作中,27 例已知脑脊液渗漏 ( ) 其中 9 例已知脑脊液渗漏的患者 ( ) 已接种疫苗(9 例患者接种了 23 价肺炎球菌疫苗,2 例接种了脑膜炎球菌血清型 疫苗,1 例患者接种了 A 型脑膜炎球菌血清型和 B 型流感嗜血杆菌疫苗)。肺炎链球菌培养33次( ),流感嗜血杆菌培养11次 ( )。最常见的肺炎球菌血清型为3型(4例)、35B型、 38型和15C型(各2例)。流感嗜血杆菌在所有 10 次发作中均未包膜,具有已知的胶囊类型。结果在8次发作中呈不良状态( ),无患者死亡。
Conclusions. Bacterial meningitis in patients with CSF leakage has a high recurrence rate, despite surgical repair or vaccination, and outcome is generally favorable. CSF leakage should be suspected in patients with bacterial meningitis presenting with liquorrhea, recurrent meningitis, or with disease caused by . influenzae.
结论。脑脊液渗漏患者的细菌性脑膜炎复发率很高,尽管进行了手术修复或接种疫苗,但结果总体上是有利的。对于表现为胃泻、复发性脑膜炎或由 引起的 疾病的细菌性脑膜炎患者,应怀疑脑脊液渗漏。流行性感冒。
Keywords. cerebrospinal fluid leakage; risk factor; bacterial meningitis.
Risk factors for community-acquired bacterial meningitis include immunocompromise, distant foci of infection, and anatomic deficits in the natural barriers of the brain [1-4]. Anatomic defects can be caused by congenital abnormalities of the skull, through contiguous spread of infection during ear and sinus infections, or after neurosurgery, ear-nose-throat (ENT) surgery, or neurotrauma, which can all lead to cerebrospinal fluid (CSF) leakage [5, 6]. Bacterial meningitis in patients with CSF leakage can be classified as community acquired, in case of anatomic defects or contiguous spread of infection, or nosocomial or healthcare-associated meningitis after surgery for trauma . Symptoms suggestive of CSF leakage include rhinorrhea and otorrhea, but CSF leakage may also go
社区获得性细菌性脑膜炎的危险因素包括免疫功能低下、远处感染灶和脑天然屏障的解剖缺陷[1-4]。解剖缺陷可由颅骨先天性异常、耳部和鼻窦感染期间、神经外科手术、耳鼻喉手术或神经创伤后感染的连续扩散引起,这些都可能导致脑脊液(cerebrospinal fluid, CSF)渗漏[5,6]。脑脊液渗漏患者的细菌性脑膜炎可分为社区获得性脑膜炎,如果解剖学缺陷或感染连续扩散,或创伤手术后院内或医疗相关的脑膜炎 。提示脑脊液渗漏的症状包括流涕和耳漏,但脑脊液渗漏也可能消失
Received 24 April 2019; editorial decision 1 July 2019; accepted 11 July 2019; published online July 12, 2019.
收稿日期: 2019-04-24;编辑决定 2019年7月1日;2019年7月11日接受;2019年7月12日在线发布。
Correspondence: D. van de Beek, Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, PO Box 22660. 11000D Amsterdam. The Netherlands (d.vandebeek@amc..vva.ni).
通信:D. van de Beek,阿姆斯特丹神经科学系,阿姆斯特丹大学医学中心,阿姆斯特丹大学医学中心,邮政信箱22660。11000D阿姆斯特丹。荷兰 (d.vandebeek@amc..vva.ni)。

Clinical Infectious Diseases 2020;70(11)2256-61
临床传染病 2020; 70(11)2256-61

(c) The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses) by-nc-nd/4.0/. which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com DOI: 10.1093/cid/ciz649 unnoticed [9]. In patients with skull-base fracture due to head trauma, CSF leakage resolves spontaneously within 24 hours after onset , but once persistent, meningitis occurs in of patients . Cerebrospinal fluid leakage has previously been reported in of patients with communityacquired bacterial meningitis and in of patients with recurrent meningitis [13-16]. We evaluated patients with bacterial meningitis associated with identified CSF leakage from a prospective nationwide cohort study in adults with communityacquired bacterial meningitis.
(c) 作者 2019.由牛津大学出版社为美国传染病学会出版。这是一篇开放获取文章,根据知识共享署名-非商业性使用-禁止演绎许可 ( http://creativecommons.org/licenses) by-nc-nd/4.0/ 的条款分发。允许以任何媒介对作品进行非商业性复制和发行,前提是原始作品不得以任何方式更改或转换,并且该作品被正确引用。如需商业再利用,请联系 journals.permissions@oup.com DOI: 10.1093/cid/ciz649 unnotice [9]。在颅底骨折因头部外伤的患者中,脑脊液渗漏在发病 后 24 小时内自行消退,但一旦持续存在,患者 就会发生 脑膜炎。既往有社区获得性细菌性脑膜炎患者和 复发性脑膜炎患者脑脊液渗漏的报道 [13-16]。我们评估了与已确定的脑脊液渗漏相关的细菌性脑膜炎患者,该研究来自一项针对社区获得性细菌性脑膜炎成人的前瞻性全国性队列研究。


In the MeninGene study, a nationwide observational cohort study in the Netherlands, we prospectively included 2022 episodes of community-acquired bacterial meningitis. Methods of the cohort have been described in detail previously [13]. In summary, patients over 16 years old with CSF cultureconfirmed community-acquired bacterial meningitis were included between January 2006 and December 2017. The patients were listed in the database of the Netherlands Reference Laboratory for Bacterial Meningitis; this database receives CSF and blood samples from over of all patients with bacterial meningitis in the Netherlands and provides daily updates to the researchers after which the treating physicians were contacted.
在荷兰的一项全国性观察性队列研究 MeninGene 研究中,我们前瞻性地纳入了 2022 例社区获得性细菌性脑膜炎发作。该队列的方法先前已详细描述[13]。总之,2006 年 1 月至 2017 年 12 月期间纳入了 16 岁以上经脑脊液培养确诊的社区获得性细菌性脑膜炎患者。这些患者被列入荷兰细菌性脑膜炎参考实验室的数据库;该数据库接收来自荷兰所有细菌性脑膜炎患者 的脑脊液和血液样本,并向研究人员提供每日更新,然后联系治疗医生。
Written informed consent was obtained from all participating patients or their legal representatives. We excluded patients with hospital-acquired meningitis, patients with recent (within 1 month) head injury or neurosurgery, and patients with neurosurgical devices.
Data on patients' characteristics, symptoms and signs on admission, laboratory results, radiological examination, treatment, and outcome were prospectively collected with an online case record form (CRF). In this CRF we defined predisposing factors for developing bacterial meningitis such as otitis media, sinusitis, pneumonia, endocarditis, remote neurosurgical procedure or head trauma, and an immunocompromised state (eg, caused by use of immunosuppressive drugs, splenectomy, diabetes mellitus, cancer, alcoholism, or human immunodeficiency virus). The CRF also included a standard question on the presence or absence of CSF leakage, of which the judgment was left to the discretion of the treating physician. If CSF leakage was reported, additional information was retrospectively collected and all discharge letters were screened for causes of leakage, duration of leakage, the presence of liquorrhea, number of recurrent episodes, vaccination policy, and treatment of CSF leakage. At discharge, neurological examination was performed and this outcome was graded according to the Glasgow Outcome Scale (GOS), with outcome scores varying from 1 (death) to 5 (good recovery). A favorable outcome was scored as 5 and an unfavourable outcome was scored as 1-4.
通过在线病例记录表 (CRF) 前瞻性收集有关患者入院时的特征、症状和体征、实验室结果、放射学检查、治疗和结果的数据。在本CRF中,我们定义了发生细菌性脑膜炎的诱发因素,如中耳炎、鼻窦炎、肺炎、心内膜炎、远程神经外科手术或头部外伤,以及免疫功能低下状态(例如,由使用免疫抑制药物、脾切除术、糖尿病、癌症、酗酒或人类免疫缺陷病毒引起)。CRF还包括一个关于是否存在脑脊液渗漏的标准问题,其判断由主治医师自行决定。如果报告了脑脊液渗漏,则回顾性收集其他信息,并筛查所有出院信的渗漏原因、渗漏持续时间、是否存在腹泻、复发次数、疫苗接种政策和脑脊液渗漏的治疗。出院时,进行神经系统检查,并根据格拉斯哥结果量表 (GOS) 对结果进行分级,结果评分从 1(死亡)到 5(恢复良好)不等。有利的结果得分为5分,不利的结果得分为1-4。
Statistical analyses were conducted with the use of SPSS statistical software, version 24 (SPSS, Inc). We used descriptive statistics for baseline characteristics. To identify differences between episodes in patients with and without CSF leak-associated bacterial meningitis we used Mann-Whitney test for continuous data. For categorical data the chi-square test and Fisher's exact test were used. All tests were 2 -tailed, and was considered significant.
使用SPSS统计软件第24版(SPSS,Inc)进行统计分析。我们对基线特征使用描述性统计。为了确定有和没有脑脊液渗漏相关细菌性脑膜炎患者发作之间的差异,我们使用 Mann-Whitney 检验获得连续数据。对于分类数据,使用卡方检验和 Fisher 精确检验。所有测试均为 2 尾,并 被认为具有显著性。


Over the 12-year period, CSF leakage was reported in 65 of 2022 episodes (3%) of community-acquired bacterial meningitis (Table 1) in 53 patients. The median age was 51 years (interquartile range [IQR], 40-61 years) and 33 were male ( ). Upon admission, CSF leakage was reported in 40 of 65 episodes ( ), most commonly rhinoliquorrhea ( 31 of 40 episodes [76%]). On presentation, the triad of fever, neck stiffness, and altered mental status was present in 20 of 63 episodes ( ); and in 43 of 64 episodes ( ) the duration of symptoms was shorter than 24 hours. In 31 of 65 episodes ( ), the patients presented with a Glasgow Coma Scale (GCS) score of less than 14, indicating an altered mental state. The duration of symptoms at the moment of presentation was shorter in episodes with CSF leak-associated meningitis compared with other meningitis episodes included in the cohort ( hours in 43 of 64 [67%] vs 869 of 1877 [46%]; ) (Supplementary Table 1). Fewer patients presented with an altered mental state, defined as a score on the GCS of less than 14, in episodes associated with a CSF leak ( 31 of 65 [48%] vs 1364 of 1945 [70%]; ). The cause of CSF leakage was identified in 49 episodes ( ): ENT surgery in 19 episodes ( ), remote head trauma in 15 ( ), previous neurosurgery in 4 ( ), malignancy in , a congenital defect in , and were diagnosed with idiopathic intracranial hypertension (Table 1).
在 12 年期间,2022 年社区获得性细菌性脑膜炎发作中有 65 例 (3%) 报告了 53 例患者的脑脊液渗漏(表 1)。中位年龄为 51 岁(四分位距 [IQR],40-61 岁),33 岁为男性 ( )。入院时,65 次发作中有 40 次报告脑脊液渗漏 ( ),最常见的是鼻漏(40 次发作中有 31 次 [76%])。就诊时,63 次发作中有 20 次出现发热、颈部僵硬和精神状态改变三联征 ( );在64次发作 中,有43次症状持续时间短于24小时。在 65 次发作中的 31 次 ( ),患者的格拉斯哥昏迷量表 (GCS) 评分低于 14,表明精神状态改变。与队列中包括的其他脑膜炎发作相比,脑脊液渗漏相关脑膜炎发作时症状的持续时间更短(64 例中有 43 例 [67%] vs 1877 例中有 869 例 [46%]; )(补充表1)。在与脑脊液渗漏相关的发作中,出现精神状态改变(定义为 GCS 评分低于 14)的患者较少(65 例中有 31 例 [48%] vs 1945 年有 1364 例 [70%]; )。脑脊液渗漏的病因49例 ( ):耳鼻喉科手术19例 ( ),远端颅脑外伤15例 ( ),既往神经外科手术4例( ),恶性肿瘤, 先天性缺陷, 诊断为特发性颅内压增高(表1)。
Thirty-eight of 65 episodes (59%) had a history of meningitis prior to the current episode. In 20 of 38 episodes (53%), the recurrence occurred despite previous surgery aimed at closing the leak. Of the patients with a first episode of CSF leak-associated meningitis, 10 of 27 episodes (37%) were due to a previously identified CSF leak. Other predisposing factors for bacterial meningitis than CSF leakage were present in 23 of 65 episodes ( ), most commonly ear or sinus infections ( 16 of ) and pneumonia ( 4 of 23 [17%]). An immunocompromised state was present in 7 of 65 episodes ( ), which was due to the use of immunosuppressive drugs , diabetes , or alcoholism .
65 例中有 38 例 (59%) 在本次发作前有脑膜炎病史。在 38 次发作中的 20 次 (53%) 中,尽管先前进行了旨在闭合渗漏的手术,但复发还是发生了。在首次发作脑脊液漏相关性脑膜炎的患者中,27 次发作中有 10 次 (37%) 是由于先前发现的脑脊液漏所致。除脑脊液渗漏外,细菌性脑膜炎的其他诱发因素见于 65 例发作中的 23 例 ( ),最常见的是耳部或鼻窦感染 ( 16 例 ) 和肺炎 ( 4 例 / 23 例 [17%])。在65次发作中,有7次出现免疫功能低下状态( ),这是由于使用免疫抑制药物 、糖尿病 或酗酒 所致。
Brain imaging was performed in 53 of 65 episodes ( ) (Figure 1) and consisted of cranial computed tomography (CT) in all 53 episodes and cranial magnetic resonance imaging (MRI) with 3-dimensional (3D) constructive interference in steady state (CISS) in 11 of 53 episodes (21%). Cerebrospinal fluid markers ( -2 transferrin test and -trace) were used in 17 episodes and confirmed CSF leakage in 14 episodes. Cranial imaging could localize the anatomic location of CSF leakage in 60 of 65 episodes (92%). In 4 additional episodes (6%) the CSF leakage was revealed by a -2 transferrin test, and in 1 episode (2%) the CSF leak was found using myelography with intrathecal contrast. For 27 of 65 episodes ( ), endoscopic surgical repair of the defect was scheduled after recovery. Surgical outcome in these episodes could be retrieved in 17 episodes (63%). For 11 of 17 episodes it was the first attempt of surgical repair and had a success rate of ( 10 of 11 episodes) after a follow-up between 3 months and 6 years.
在 65 次发作中的 53 次进行了脑成像 ( ) (图 1),包括所有 53 次发作的颅脑计算机断层扫描 (CT) 和 53 次发作中的 11 次 (21%) 的颅脑磁共振成像 (MRI) 和 3 维 (3D) 建设性干扰稳态 (CISS)。脑脊液标志物( -2转铁蛋白试验和 -trace)在17次发作中使用,在14次发作中确认脑脊液渗漏。颅脑影像学检查可在 65 例发作中的 60 例 (92%) 中定位脑脊液渗漏的解剖位置。在另外 4 次发作 (6%) 中, 通过 -2 转铁蛋白试验显示脑脊液渗漏,在 1 次发作 (2%) 中,使用脊髓造影和鞘内造影剂发现脑脊液渗漏。对于 65 次发作中的 27 次 ( ),计划在恢复后对缺损进行内窥镜手术修复。这些发作的手术结果可以在 17 次发作 (63%) 中恢复。对于 17 集中的 11 集,这是第一次手术修复尝试,在 3 个月至 6 年的随访后,成功率为 (11 集中的 10 集)。
Lumbar puncture was performed in all episodes and showed a median opening pressure of ). The median CSF leukocyte count in episodes with CSF leak-associated meningitis was 4870 (IQR, 1840-7927), and an elevated white blood cell count (WBC) in CSF of over 1000 cells was present in 54 of 61 episodes ( ). In 57 of 65 episodes ( ) at least 1 independent predictor of bacterial meningitis (glucose concentration, ; ratio of glucose concentration to blood glucose concentration, ; protein concentration, ; WBC count, cells ; or CSF neutrophil count, cells ) was present in the .
所有发作均进行腰椎穿刺,中位开口压为)。 脑脊液渗漏相关性脑膜炎发作的中位脑脊液白细胞计数为 4870 (IQR, 1840-7927),61 次发作中有 54 次脑脊液白细胞计数 (WBC) 升高超过 1000 个细胞 )。在 65 次发作中的 57 次 ( ) 中,至少有 1 个细菌性脑膜炎的独立预测因子(葡萄糖浓度、 葡萄糖浓度与血糖浓度之比 蛋白质浓度、 ;白细胞计数, 细胞 ;或脑脊液中性粒细胞计数, 细胞 )存在于 .
The CSF culture in episodes with CSF leak-associated meningitis identified the causative organism in 53 of 65 episodes
脑脊液渗漏相关脑膜炎发作的脑脊液培养在 65 次发作中的 53 次中确定了致病微生物
Table 1. Characteristics of 53 Patients With a Cerebrospinal Fluid Leakage With 65 Bacterial Meningitis Episodes
表 1.53例脑脊液渗漏伴65例细菌性脑膜炎发作患者的特征
Characteristics 特性 Values  Characteristics 特性 Values 
Median (UQR) age,
中位年龄 (UQR),
Index of CSF-Inflammation
Male sex 男性 (62)  (62) Leukocyte count (cells )
Eause of CSF leak
Remote head trauma 远程头部外伤 cells
(12)  (12)
Neurosurgery 神经外科 Mëdian (IOR) protein,
ENT surgery 耳鼻喉科手术 19/66 (29) Median (IOR) CSF to blood glucose ratio
中位 (IOR) 脑脊液与血糖比值
Congenital 先天 6/85 (9) Median (1OR) blood chemical test result
中位 (1OR) 血液化学检测结果
Tumor  ESR,  ESR, 7 (3-29)
Other" 其他” C-reacinie protein, wgg C-reacinie 蛋白 (wgg)
Unknown 未知 Thrombocytes,  血小板, 225 (191-266)
Presumed onset time of CSF leak
Causative organism 致病微生物
s1 year S1 年 Streptococcus pneumoniae
year  Haemophitus influenzao 流感血孢
210 years 210 岁 Neisseria meningitidis 脑膜炎奈瑟菌
Unrevesled leak at:fust episode
未解泄的泄漏时间:fust episode
(26)  (26) Other organismo 其他生物体 जin  ज在
CSF leak identified on CTMRI
CTMRI 发现脑脊液渗漏
(92)  (92) Negative culture 消极文化
Equorrhea 国漏 Fransfer to lCU department
Fransfer 到 lCU 部门
20/64 (31) 当
Rhinoliquorrhea 犀牛病 Impaired consciousness during admission
19/62 (31)
Otoliquorrhea 耳漏 Systemic complications 全身并发症
Both  Respiratory failure 呼吸衰竭 (8)  (8)
Erevious vaccination Erevious 疫苗接种 Circulatory shock 循环休克
Previous surgery for CSF leakage
23/65 (35) Neurologic complications
Surgery during or after admission
27/65 (42) Seizures 发作 (16) Iㅏ읙ㄴ  (16) Iᅡ읙ᄂ
Recurrence 复发 (59)  (59) Cerebrovascular accident
1 ime 1 个 IME Score on GOS  在GOS 上得分
times  (23)  (23) 1 (Death) 1 (死亡)
times  2 Negetative state): 2 否定状态):
Predisposing factors 诱发因素 23/65 (35) 3 (Severely disabled) 3 (严重残疾)
timmunocompromised state
4. Moderately disabledr 4.中度残疾者
Pneumonia 肺炎 (6)  (6) 5 (No or minor disability)
5 (无残疾或轻微残疾)
Ofitis media Ofitis 媒体 8885 (12) Sequelae at discharge 出院时的后遗症
Sinusitis 窦炎 Cognitive impairment 认知障碍 (9)  (9)
Symptoms on presentation
Monofhemiparesis 单偏瘫
Headache 头痛 (92)  (92) Cranial nerve palsy 颅神经麻痹
Neck stiffness 颈部僵硬
Temperature  温度 47164 (23)
Focal neurological deficits
Triad of symptoms
20/83 (32)
Score on GCS GCS评分
Mecian (IOR) 梅西亚 (IOR) 14. (II)-15) 14.(二)-15)
Data are presented as unless othervise noted.
除非另有说明,否则数据均以 其他方式呈现。
Abbreviaions: CSF, cerebrospinal fluid; CT, computed tomography; ENT, ear-nose-throat; ESR, erychrocye sedimentation rate; GCS, Glasgow Coma Scale; GOS, Glasgow outcome scale: ICU. intensive care unit: IQR. interquartile range; MRI. magnetic resonance imaging.
缩写:CSF,脑脊液;CT,计算机断层扫描;耳鼻喉科,耳鼻喉;ESR, 红细胞沉降速率;GCS,格拉斯哥昏迷量表;GOS,格拉斯哥结果量表:ICU。重症监护病房:IQR。四分位距;核磁共振成像。磁共振成像。
'Other etiology: idiopathic intracranial hypenension, enlarged Meckel's cave.
Focal neurological deficits defined as aphasia or hemiparesis or cranial nerve palsies and hearing loss.
'Triad of symptoms a fover. neck stiffness, and change in mental status.
  1. ii!
indicates a change in mental status, s8 indicates come.
'Other organısms: Streptococous salivarius, Streptococcus agalactiae, Escrerichia coli, Streptococcus mitis.
'Neurological complications defined as impaired consciousness or seizures or focal neurological deficits or cerebrovascular accidents or sinus thrombosis.
(82%); in an additional 2 episodes the pathogen could be identified through blood culture, and in 1 episode the pathogen was identified by polymerase chain reaction. Streptococcus pneumoniae was identified in 33 of 65 episodes ( ) and
(82%);在另外 2 次发作中,病原体可以通过血培养进行鉴定,在 1 次发作中,病原体通过聚合酶链反应进行鉴定。肺炎链球菌在 65 次发作中的 33 次被发现 ( ) 和

Haemophilus influenzae in 11 episodes (17%). Other causative agents, as identified by CSF or blood culture, were Streptococcus agalactiae in 4 episodes (6%), Streptococcus salivarius in 3 episodes (5%), Streptococcus mitis in 3 episodes (4%), Neisseria
流感嗜血杆菌 11 次发作 (17%)。通过脑脊液或血培养鉴定的其他病原体是 4 次 (6%) 的无乳链球菌、3 次 (5%) 的唾液链球菌、3 次 (4%) 的螨丝链球菌、奈瑟菌
Figure 1. A-D, Examples of cranial imaging in patients with CSF leak-associated bacterial meningitis. Coronal cranial CT (A) and sagittal 30 CISS-weighted cranial MRI showing a defect of the lamina cribrosa (arrow in ) and CSF collection in the nasopharynx (arrow in B). C. Three-dimensional CISS-weighted sagittal MRI showing defect of the skull base below the crista Galli (arrow in 9. D. Threedimensional CISS-weighted sagittal MRI showing CSF leak into the sphenoid sinus (arrow in D). Abbreviations: CISS, constructive interference in steady state; CSF. cerebrospinal fluid; CT, computed tomography: MRI, magnetic resonance imaging: 3-D, 3-dimensional.
图 1.A-D,脑脊液渗漏相关细菌性脑膜炎患者的颅脑成像示例。冠状颅 CT (A) 和矢状面 30 CISS 加权颅脑 MRI 显示筛板缺陷(箭头) 和鼻咽脑脊液收集(B 箭头)。C. 三维 CISS 加权矢状 MRI 显示 Crista Galli 下方颅底缺损(9 中的箭头。 D. 三维 CISS 加权的矢状 MRI 显示 CSF 泄漏到蝶骨窦中(D 中的箭头)。缩写:CISS,稳态建设性干涉;脑脊液。脑脊液;CT、计算机断层扫描:MRI、磁共振成像:3D、3D。
meningitidis in 1 episode (2%) and Escherichia coli in 1 episode (2%). The causative pathogen was not identified in 9 of 65 episodes ( ). The distribution of serotypes of . pneumoniae was type 3 in 4 episodes ( ); types