重症单核细胞增多性李斯特菌脑膜脑炎1例 (1)

通信作者:王冯滨

Correspon ding au th or.WANG Feng-Bin,E-m ail:wangfengbin@s ·病例分析·

重症单核细胞增多性李斯特菌脑膜脑炎1例

刘袁媛1,张文宏2,王冯滨1

1.上海市(复旦大学附属)公共卫生临床中心,上海201508;

2.复旦大学附属华山医院感染科,上海200040

摘　要:李斯特菌脑膜脑炎是单核细胞增多性李斯特菌(LM)引起的细菌性脑膜脑炎,通常发生于免疫功能低下者。LM是人畜共患致病菌,通过污染的食物传播。欧美国家报道较多,国内报道较少。李斯特菌脑膜脑炎病死率高,临床表现与其他细菌性脑膜炎类似。脑脊液检查与结核性脑膜炎亦难鉴别,确诊依赖于脑脊液涂片及培养。本文报道1例重症李斯特菌脑膜脑炎,患者为免疫力正常的菲律宾籍中年女性,急性起病,先后以病毒性脑膜脑炎及结核性脑膜炎治疗,病情进展快,发病3周出现呼吸衰竭,气管插管呼吸机辅助通气。脑脊液培养见LM后,予氨苄西林联合氨基糖苷类药物治疗3周,患者意识恢复,病情好转出院。本病例报道总结了李斯特菌脑膜脑炎的临床特点、危险因素及治疗转归。

关键词:单核细胞增多性李斯特菌;重症脑膜脑炎;临床表现

A case report of severe meningoencephalitis caused by Listeria monocytogenes

LI U Yuan-Yuan1,Z HANG Wen-H ong2,WANG Feng-Bin1

1.Shanghai Public Health Clinical Center Affiliated to Fudan University,Shanghai201508,China;

2.Department of I nfectious Diseases,Huashan Hospital,Fudan University,Shanghai200040,C hina

A bstract:L isteria meningoe nce phalitis is a kind of bacter ial meningoe nce phalitis caused by Listeria monocytogenes(LM),which m ost of ten occ urs in immunocompromised persons.LM is a zoonotic pathogen tra nsmitted thr ough c ontam inated f ood.Historically,Eur ope and the United Sta tes have repor ted a gre ater number of inf ections,while inf ections in China ar e re por ted r ar ely.With its high mor tality,it is diff icult to diagnose L isteria meningoencephalitis due to the fa ct that the clinical m anif esta tions ar e similar to other ba cterial meningitis.I t is also dif ficult to distinguish L isteria meningoencephaliti s f r om tuberc ulous meningitis via cer ebrospinal f luid.Diagnosis depends on the results of the cer ebrospin al f luid smear and cultur e.I n the pr esent pa per,a case of seve re Listeria me ningoencephalitis is r epor ted.A middle-aged woman f rom the Philippines with nor mal imm une f unction is pr esente d with a cute onset of illness whose condition dete rior ated rapidly despite r eceiving r outine ther apy for vir al meningoencephalitis and tuberc ulous meningitis.R espir ator y f ailur e occurr ed three weeks a fter onse t of illness and tr ache al intubation and mechanical ventilation became necessary.After LM was found in cer ebrospin al fluid,am picillin combined with aminoglycoside was administer ed for thre e we eks.The patien t recove red f ully and was discha rge d. Her e we summ arize the clinical fe atur es,r isk f actors,pr ogression and outcome of Listeria meningoencephalitis.

Key words:Listeria monocytog enes;Sever e meningoe nce phalitis;Clinic al m anif estation

·

153·

微生物与感染　Journal of Microbes and I nfections,September25,2011,6(3):153-157　http:∥