Clinical Presentations and the Bacterial Meningitis Score in Children with Cerebrospinal Fluid (CSF) Pleocytosis = 무균성 뇌수막염 소아의 임상양상 및 Bacterial Meningitis Score의 적용 후 평가

국문 초록 (Abstract)

목 적 : 뇌척수액에서 세포가 증가된 환자에서 세균성 뇌수막염의 비율은 무균성 뇌수막염에 비해 낮으며 국내에서 예방접종의 도입 및 투여율의 증가로 세균성 뇌수막염의 위험성은 감소하였다. 하지만 소아에서 무균성 뇌막염과 세균성 뇌수막염의 감별은 쉽지 않으며 대부분의 환자들은 척수액 배양 검사 결과의 확인 까지 입원 및 항생제 치료를 받고 있다. 이에 저자들은 뇌척수액에서 세포가 증가된 환자 40명을 대상으로 임상 증상, 뇌척수액 소견 및 BMS를 분석하였다.
방 법 : 2012년 1월부터 2013년 1월까지 강남세브란스 병원에서 척수액 검사를 시행한 소아(생후 2개월 15세) 환아를 대상으로 후향적으로 조사하였다.
결 과 : 임상 증상은 발열(92.5%), 두통(87.5%) 및 구토(75%) 순으로 나타났고 정부 강적은 전체의 약 20% 환자에서 보였다. 3세 미만의 환아는 모두 3명으로 이들은 모두 특정적인 뇌막 자극 증상을 보이지 않았다. 전체 환자 중 36명(90.0%)에서 입원 치료를 하였고 재원 기간은 3일이었다. 뇌척수액 검사상 백혈구수는 156 cell/㎣ (11-680), 단백질은 평균 38㎎/dL(12-90), 당은 평균 66㎎/dL(44-102)이었다. 말초 혈액 소견상 다핵구가 10，000㎣ 이상이 20%의 환아에서 확인되었다. 세균성 수막염이 확인된 환아는 없었다. BMS가 전체 환아들을 대상으로 조사되었고, 이중 27명(67.5%)에서 세균성 수막염의 가능성이 낮은 분류인 0점, 13명(32.5%)에서는 1점으로 기록되었다.
결 론: BMS는 국내에서도 뇌척수액 검사의 세포수가 증가된 환아를 평가함에 있어 적절한 치료 방침이 될 수 있을 것으로 판단된다. BMS가 무균성 뇌수막염 환아의 입원 비율과 항생제 사용을 안전하게 감소 시킬 수 있을 지를 판단하기 위해서는 국내에서 지속적인 연구가 필요할 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: The differential diagnosis between aseptic meningitis and bacterial meningitis in children is often very difficult, The current study was performed to investigate the clinical presentations, cerebrospinal fluid (CSF) and the Bacterial Meningitis Score (BMS) in children presenting with CSF pleocytosis (≥10 WBC/㎣),
Methods: We retrospectively analyzed medical records of children (age three months-15 years) with CSF pleocytosis between January 2012 to January 2013 at Gangnam Severance Hospital.
Results: The dominant clinical symptoms were fever (92,5%), headache (87,5%), and vomiting (75%), Neck stiffness was noted in 20% of the patients, Three patients who were younger than three years old could not properly present meningeal signs, The majority (36 patients, 90%) were hospitalized, with a median stay of three days. There was no one who had bacterial meningitis, The BMS was calculated for all patients, Among them, 27 patients (67,5%) showed a BMS of 0 which represents very low risk for bacterial meningitis and the remaining 13 patients (32,5%) showed a BMS of 1.
Conclusion: The BMS may be helpful to guide clinical decision making for the management of children with CSF pleocytosis, Additional multicenter studies in Korea are now needed to evaluate whether the BMS can be used to safely reduce hospital admission and antibiotic use for children with aseptic meningitis.

목차 (Table of Contents)

• Abstract
• Introduction
• Materials and Methods
• Results
• Discussion
• 국문요약
• Reference

참고문헌 (Reference)

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