3例婴儿脑膜炎败血伊丽莎白菌脑膜炎临床分析

总结脑膜炎败血伊丽莎白菌感染患儿的临床特点，以期提高临床诊治水平。收集中山市博爱医院2010年1月至2020年12月收治的3例脑膜炎败血伊丽莎白菌引起的脑膜炎患儿临床资料，结合相关文献进行总结分析。结果显示，3例患儿脑脊液中培养出脑膜炎败血伊丽莎白菌，其中2例血培养为同种细菌。3例患儿均为足月顺产，2例为新生儿期发病，1例为出生后35天发病，起病前均未发现致病高危因素。患儿以发热为主要起病表现，无抽搐及脑膜刺激征表现。3例患儿外周血常规白细胞总数、C反应蛋白、降钙素原均升高；脑脊液潘氏试验均为阳性，伴脑脊液白细胞数增高，脑脊液蛋白明显增高，脑脊液葡萄糖降低。头颅磁共振成像(magnetic resonance imaging，MRI)或电子计算机断层扫描术(computer tomography，CT)可见脑膜强化、软脑膜增厚、脑外间隙增宽，均无脑实质受累。3例检出菌株的药敏结果表现出高度一致性，均提示对环丙沙星、哌拉西林/他唑巴坦、左氧氟沙星、复方新诺明敏感。2例患儿以环丙沙星治疗，1例患儿以美罗培南联合万古霉素治疗。其中1例治愈，2例临床症状好转后出院。经电话随访，3例患儿一般情况尚可，无生长发育异常。本病例报道提示，脑膜炎败血伊丽莎白菌脑膜炎主要见于新生儿期，以发热起病为主要表现，该菌对儿科常用抗菌药物多显示体外耐药，对喹诺酮类药物敏感。

Clinical features of 3 cases of infants with Eliz abethkingia meningoseptica meningitis

To summarize the clinical features of Elizabethkingia meningoseptica(EM) meningitis in infants. Case histories (including clinical features, laboratory examination, treatment, prognosis) of 3 EM meningitis in infants who were hospitalized at Boai Hospital from January 1, 2010 to December 31, 2020 were analyzed retrospectively. 3 cases were diagnosed by a positive cerebrospinal fluid culture of EM. 3 cases were full-term natural delivery, 2 cases were neonatal onset, 1 case was 35 days onset, no risk factors were found before onset. Fever was the main symptom, no convulsions and meningeal irritation sign. Peripheral blood leucocyte count, C-reactive protein and procalcitonin of 3 cases were increased. Pan's test of cerebrospinal fluid (CSF) was positive, the nucleated cell count in CSF was elevated; the protein level was substantially elevated; the glucose level was decreased. Representation of CT or MRI examination showed meningeal enhancement, without brain parenchyma involvement. The results of drug sensitivity of 3 strains showed high consistency. Drug sensitivity test showed that bacteria were all sensitive to ciprofloxacin, piperacillin/tazobactam, levofloxacin and cotrimoxazole. 2 cases were treated with ciprofloxacin, 1 case was treated with meropenem combined with vancomycin, one case was cured, and two cases were discharged after clinical improvement. Telephone follow-up showed that the general condition of 3 cases was normal. EM meningitis mainly occurs in the neonatal stage, fever was the main manifestation. EM was resistant to the antimicrobials which had been commonly used in the department of pediatrics in vitro and sensitive to quinolones.