尿路感染合并无菌性脑膜炎1例报告及文献复习

摘要

Objective To analyze and investigate clinical characteristics, pathogenesis and treatment of urinary tract infection and aseptic meningitis. Methods Clinical features and laboratory tests of a two-month-old baby girl with urinary tract infection and aseptic meningitis were reported. Results The patient complained of fever, neck stiffness and a bulging fontanel, accompanied by congestion and abnormal secretion of urethra. The cerebrospinal lfuid (CSF) white blood cell count was 30×106/L. The blood culture and the CSF culture were both negative. And the urine culture was positive for Enterococcus faecium. The patient received a 10-day course of intravenous antibiotic therapy. The prognosis is good with no recurrence of the disease. Conclusions Aseptic meningitis can be concomitant with urinary tract infection, The probable hypothesis may be that sterile CSF pleocytosis is mediated by urinary tract infection. Knowledge of this may prevent unnecessary antibiotics therapy for presumed bacterial meningitis.%目的：探讨尿路感染合并无菌性脑膜炎的临床特点、发病机制及诊治，以提高对此疾病的认识。方法分析1例尿路感染合并无菌性脑膜炎患儿的临床特点和实验室检查结果，并复习相关文献。结果患儿2月龄，临床表现为发热、颈抵抗及前囟隆起，伴有尿道口充血及异常分泌物。脑脊液白细胞计数30×106/L。患儿血培养、脑脊液培养均阴性。尿培养为屎肠球菌生长。经静脉抗感染治疗10 d，病情好转，随访病情无复发。结论尿路感染患儿可合并无菌性脑膜炎，其机制可能与细菌感染引起脑膜炎症反应有关，临床上需与细菌性脑膜炎进行鉴别，如明确为前者可适当缩短抗感染疗程。