ObjectiveTo systematically review the quality of evidence-based guidelines (EBGs) on medication therapy for neonatal bacterial meningitis, and compare differences and similarities of the drugs recommended, in order to provide references for clinical application. MethodsDatabases such as the TRIP, PubMed, CNKI, VIP, WanFang, CBM, National Guideline Clearinghouse and Guidelines International Network were searched to collect evidence-based guidelines on medication therapy for neonatal bacterial meningitis. Methodological quality of included studies was assessed according to the AGREE Ⅱ instrument, and the differences and similarities among recommendations were compared. ResultsA total of 4 EBGs were included. Among them, one guideline was developed by the America and three guidelines were by the UK. Only one guideline was developed specially for neonates, while the rest were for neonates and children of different ages. According to the AGREE Ⅱ instrument, "scope and purpose", "stakeholder involvement", "rigor of development", "clarity and presentation", "applicability" and "editorial independence" were scored more than 60%. The recommendations of different guidelines were basically the same, only with conflicts in some areas. ConclusionAlthough most guidelines concerning neonatal bacterial meningitis are of high quality, grading levels of evidence and strength of recommendation should be unified.
目的：探讨成人化脓性脑膜炎合理有效的诊治方法和影响预后的因素。方法：对我院2001年1月～2007年4月成人化脓性脑膜炎患者的病历资料进行回顾性分析。结果：20例痊愈，2例自动出院，2例死亡。结论：早期诊断，早期合理使用抗生素，适当使用肾上腺皮质激素和脱水剂，改善脑代谢药物，患者大多预后好。诊治开始时间、患者年龄及伴发疾病是决定预后的关键。
Objective To detect the changes of function of blood-aqueous barrier in different Syndrome stages of patients with Vogt-Koyanagi-Harada (VKH) syndrome in order to provide the appropriate therapy. Methods According to clinical manifestation, 77 patients (144 eyes) with VKH syndrome were divided into 4 groups: 10 cases in posterior uvietis stage group (20 eyes), 27 in anterior uveal involvement stage group (50 eyes), 23 in recurrent anterior uvitis stage group (41 eyes), and 17 in convalescent stage group (33 eyes). The other 50 cases (100 eyes) were in the control group. Flare and cells of anterior chamber in patient with VKH Syndrome at different stages were graded and measured by laser flare and cell meter (LFCM) and slitlamp microscope. Results According to the results of slitlamp biomicroscopy, anterior chamber flare and cells were at the 0 grade in the patients at posterior uvietis stage (20 eyes). The results of LFCM examination revealed that the flare value and cells were (9.7±3.4) pc/ms and (0.9±0.6)/0.5 mm3 in posterior uvietis stage group, and (5.3±2.3) pc/ms and (0.8±0.6)/0.5 mm3 in the control group. The differences between the two groups were significant (Plt;0.001) and insignificant (P=0.899), respectively. In anterior uveal involvement stage group, the cells in anterior chamber was at grade 1+ in 25 eyes, 2+ in 19, and 3+ in 6, respectively, while the flare was at grade 1+in 27 eyes and 2+ in 23; the number of cells in anterior chamber was (13.7±6.5)/0.5 mm3，(40.8±17.6)/0.5 mm3, and (75.7±25.5)/ 0.5 mm3 respectively, and the value of flare was (31.4±12.8) pc/ms and (133.4±59.5) pc/ms. In recurrent anterior uvitis stage group, the cells in anterior chamber was at grade 1+ in 19 eyes, 2+ in 15, and 3+ in 7, respectively, while the flare was at grade 1+ in 24 eyes and 2+ in 17; the number of cells in anterior chamber was (11.2±5.4)/0.5 mm3，(29.6±14.4 )/0.5 mm3,and (69.3±22.2)/0.5 mm3, respectively, and the value of flare was (34.94±14.3) pc/ms and (150.9±83.3) pc/ms. The flare and cells in anterior chamber both in anterior uveal involvement stage and recurrent anterior uvitis stage group were higher than that in the control group (Plt;0.001). In convalescent stage group, the cells was at grade 0 in 33 eyes and the flare was at grade 0 in 15 eyes and 1+ in 18; while the number of cells was (1.0±0.7)/0.5 mm3 which was insignificantly differed from that in the control group (P=0.310), and the value of flare was (9.5±4.8) pc/ms and (30.0±12.3) pc/ms which were both higher than that in the control group (Plt;0.001). Conclusions The breakdown of blood-aqueous barrier with different degrees occurs at each stage in VKH syndrome, whereas inflammatory cells appearing in anterior chamber are only noted at some certain stages. This is very significant to offer directional and effective treatment to the patients with VKH syndrome. (Chin J Ocul Fundus Dis, 2005, 21: 363-366)
目的:分析结核性脑膜炎的临床及治疗中影响预后的因素。方法:回顾分析10 年来我院收治的68 例结核性脑膜炎患者的临床及实验室资料。结果:59 例患者痊愈,5 例患者遗留肢体后遗症,4 例患者死亡。结论:治疗结核性脑膜炎过程中积极区分引起低钠血症的原因及鉴别药物热与类赫氏反应并给以合理治疗和对中重度和治疗效果不佳的结核性脑膜炎适时的鞘内注药可改善患者的预后。患者的体质同预后有关。
Cryptococcosis, mainly caused by Cryptococcus neoformans/gattii species complexes, is a lethal infection in both immunosuppressive and immunocompetent populations. With the upgrade of detection methods and the increase of clinical knowledge, the incidence rate of cryptococcosis is increasing, and it has become one of the most important fungi threatening human health. In recent years, great progress has been made in this field, including the taxonomy and nomenclature of Cryptococcus spp., laboratory diagnostic methods and antifungal susceptibility tests, as well as the characteristics and treatments of cryptococcosis. This article reviews the above contents, in order to improve the clinical and laboratory understanding of the Cryptococcus spp., and realize the timely diagnosis and early treatment of cryptococcosis.
Objective To retrospectively analyze the clinical information of a series of patients with cryptococcal neoformans meningitis in order to improve the diagnosis and treatment level. Methods Fifteen patients with etiological diagnosis as cryptococcal neoformans meningitis from January 2004 to December 2009 in the Affiliated Shengjing Hospital of China Medical University were included in the study. The clinical manifestations, treatment and prognosis of those patients were retrospectively analyzed. Results Seven of the total 15 patients were misdiagnosed with misdiagnosis rate of 46.7%. Twelve patients were treated by combination of amphotericin B/Lipo-AMB and fluconazole intravenously infusion, and then followed by the maintenance therapy of fluconazole orally administration, of which 7 were cured, 3 were improved, and 2 died. Five patients undergoing lumbar cisterna drainage were all cured. The follow-up study showed that 4 cases were accompanied by auditory or/and visual dysfunction within 1 to 5 years after hospital discharge. Three cases died that were not treated with anti-fungal drugs. Conclusion The misdiagnosis rate of cryptococcal neoformans meningitis is high. The keys to reduce mortality are raising vigilance, early diagnosis, rational use of antifungal drugs, and effectively lowering the intracranial pressure. The integrated therapy of amphotericin B/Lipo-AMB and fluconazole is effective and safe. Lumbar cisterna drainage can effectively lower the intracranial hypertension, quickly relieve symptoms and improve prognosis.
Anthrax is a zoonotic, acute infectious disease caused by Bacillus anthracis. Anthrax meningitis is one of the most dangerous types of anthrax, mostly secondary to cutaneous, intestinal, and pulmonary anthrax, and is a central nervous system infectious disease that is extremely lethal in the absence of timely treatment. This article reviews the clinical characteristics, pathogenesis, diagnosis and treatment of anthrax meningitis, in order to provide some reference for the clinical diagnosis and treatment of anthrax meningitis in China, and to provide reference for the further development of anthrax meningitis research.