关键词: 化脓性脑膜炎, 再发性, 病因, 抗生素治疗, 脱水治疗, 抗感染治疗

Abstract: Background　Recurrent purulent meningitis（RPM）is a rare disease in children，which is easily missed due to the complex and insidious etiology. So early detection and diagnosis in time has a positive impact on improving the prognosis. But there are few clinical studies and etiological analyses on RPM in children. Objective　To study the clinical characteristics，possible causes and treatments of RPM. Methods　Clinical data of 15 pediatric inpatients with RPM were collected retrospectively from Hebei Children's Hospital from 2012 to 2018. All cases underwent brain and spinal cord MRI，temporal bone CT scan，hearing screening or immune function test according to different possible causes of RPM，and received normal cerebral therapy（including antibiotic and dehydration treatment and so on），and treatment targeting the possible cause，as well as a post-discharge telephone follow-up ranging from 6 to 36 months. Results　Of the 15 cases，8 were male and 7 female，with an age of first onset of 24 days to 9 years old，and an average age of onset of（3.1±2.6）years old. The time to onset ranged from 4 hours to 7 days，with presentations of fever and poor mental health status in all cases. Headache and jet vomiting were found in older children，while babies had irritability and bulging of the anterior fontanelle. Cerebrospinal fluid culture was positive in 15 cases，and blood culture was positive in 8 cases. The underlying causes of 15 cases of RPM：structural abnormality in 7 cases （46.7%）〔internal ear dysplasia（4 cases），pilonidal sinus（2 cases），discontinuous cortex of skull base ethmoid plate（1 case）〕，purulent meningitis after craniofacial trauma in 3 cases (20.0%)〔brain contusion and laceration（1 case），traumatic cerebrospinal fluid rhinorrhea（1 case），traumatic tympanic membrane perforation with humoral immunodeficiency（1 case）〕，adjacent tissue inflammation in 2 cases (13.3%)〔local inflammation of sphenoid bone caused by cellulitis（1 case），cerebrospinal fluid otorrhea（1 case）〕，serious complications（2 cases）and unknown cause（1 case）. In the acute stage，the anti-infective therapy was used，and then in convalescent stage，stereotactic abscess resection，cerebrospinal fluid rhinorrhea and otorrhea repair，skull base repair，pilonidal sinus resection，regular intravenous immunoglobulin therapy or conservative treatment was used. There was no recurrence in 6 to 36 months of follow-up. Conclusion　The RPM onset in children may occur during neonatal stage to childhood stage，the etiology is complex and diverse，and structural abnormality is a main contributing factor. Timely identifying RPM，and finding and removing the possible cause，may prevent the recurrence of RPM.

Key words: Purulent meningitis, Recurrent, Etiology, Antibiotic treatment, Dehydration treatment, Anti-infective therapy