Læknablaðið - 01.12.1974, Blaðsíða 94

216
LÆKNABLAÐIÐ
7. Hjá tiltölulega mörgum sjúklingum
(38%) mistókst sýklagreining.
8. Lost og krampar voru þau einkenni,
sem virtust gefa einna verstar horfur,
en ekki meðvitundarleysi, eins og í
ýmsum öðrum uppgjörum.
9. Meðvitundarleysi og krampar komu
hlutfallslega mun tíðar fyrir hjá drengj-
um en stúlkum.
Af fjölda sjúklinga, sem höfðu fengið
sýklalyf fyrir innlagningu, má álykta, að
þau séu notuð hér á landi meira og al-
mennar en annars staðar. í öðru lagi, að
slík lyfjanotkun hafi átt einhvern þátt í
lélegri útkomu sýklagreiningar. Þá má og
vera, að hún sé að einhverju leyti með-
verkandi orsök að fremur lágri dánartölu,
lágu hlutfalli ungbarna af heildarfjölda og
háu hlutfalli drengja og stúlkna.
Helzti lærdómurinn, sem draga má af
úrvinnslu þessa verkefnis er einkum sá,
að sýklalyfjameðferðin, sem hér hefur
tíðkazt. hefur gefizt vel eftir fremur lágri
dánartölu að dæma og ennfremur að ekki
hefur verið sýnd nóg viðleitni til að kom-
ast að sýkingarorsök, s. s. með blóðrækt-
unum og smásjárskoðun með immunofluor-
ences tækni.
6 sjúklingar voru með starfrænar trufl-
anir frá taugakerfi. Komu þær ýmist í ljós
þegar fyrir brottför af sjúkrahúsinu eða
skömmu síðar.
Sjúklingum hefur ekki verið fylgt reglu-
lega eftir, svo að ekki er vitað nánar um
afdrif þeirra. Fyrirhugað er á næistunni
að rannsaka þessa sjúklinga með tilliti til
hugsanlegra afleiðinga sjúkdómsins.
SUMMARY
Vikingur H. Arnorsso^i, M.D.: Bacterial men-
ingitis in children. A 15 year survey. From
Landspitalinn, pediatric department, Reykja-
vik.
132 ehildren with bacterial meningitis were
admitted in the period 1958—1972, 85 boys and
47 girls. The youngest patient was 13 days old
and the oldest 13% years. The overall morta-
lity rai» was 9.1%. The frequency of meningo-
coccal. mfluenzal and pneumococcal meningi-
tis were 34.8, 17.4 and 4.5% respectively. The
mortalities in the same groups were 2.2. zero and
1fi.6%. A relative increase in the incidence of
H.influenzae was noted when the two last 5-
'•ear periods were compared. In 5.3% of the
patients, so called uncommon bacteriae were
found (2 cases E.coli, 2 Pyocyaneus, 1 Str.
hemolyticus, 1 Proteus and 1 Clostridium oede-
matiens) with a high mortality or 85.7%. In
approximately 38% of the patiens the causa-
tive organism could not be identified. The
mortality in this group was 8%.
The aetiological agent could not be isolated
in 51% of those patients who hat got some
antibiotic treatment prior to admission as
against 19% of those who presumably had not
been so treated.
The patients got a conventional antibiotic
treatment with 3 or 4 drugs, penicillin, suifona-
mid, chloramphenicol and/or streptomycin.
Estimated by a rather low lethality figure,
this trerapy gave good results. Certain charac-
teristics were noticed in this survey:
1. The incidence of bacterial meningitis in
children might be a little higher than in the
Scandinavian countries and USA.
2. The sex ratio (1.8) is high.
3. H.influenzae infections occurred proportio-
nately more often in girls than boys.
4. Relatively few patients had pneumococcal
infections.
5. A high proportion of patients (66%) had
received sorne antibiotic treatment prior to
admission.
6. No exact bacteriological diagnosis was estab-
lished in an unusually high proportion, or
38% of the patients.
7. Shock and convulsions gave the least favour-
able prognosis.
8. Coma and convulsions were relatively more
often seen in boys than girls.
The opinion is put forward that the features
mentioned in items 2. 3 and 6 are possibly
dependent on the antibiotic pre-treatment of
such a large proportion of the patients (item
5).
6 patients had some neurological sequelae on
discharge from the hospital or they were
noticed shortly thereafter.
No regular follow-up of the patients has
becn made, but it is planned in the near future.
HEIMILDIR
1. Barrett, F. F.. Taber, L. H., Morris, C. R.,
Stephenson, W. B., Clark, D. J., Yow. M.
D.: A 12 year review of the antibiotic
management of Hemophilus influenzae
meningitis. J Pediatr 81:370, 1972.
2. Benediktsson G.: Meningitis Serosa. Lækna-
blaðið 41:54, 1957.
3. Carpenter, R. R. & Petersdorf, R. G.: The
Clinical Spectrum of Bacterial Meningitis.
Am J Med 33:262, 1962.
4. Case Records of the Mass. Gen. Hosp. N
Engl J Med 260:1085, 1959.
5. Converse, G. M., Gwaltney, J. M. jr., Strass-
burg, D. A. & Hendley, J. O.: Alteration of
cerebrospinal fluid findings by partial
treatment of bacterial meningitis. J Pediatr
83:220, 1973.