中枢神经系统类鼻疽病的临床特点分析  

Analysis of clinical characteristics of central nervous system melioidosis(report of 12 cases)

作　　者：邹文辉[1] 李俊驹[1] 黄垂学[1] ZOU Wen-hui;LI Jun-ju;HUANG Chui-xue(Department of Neurosurgery,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院神经外科,海口570311

出　　处：《中国临床神经外科杂志》2020年第3期144-146,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的分析中枢神经系统类鼻疽病的临床特点,以指导临床诊治。方法回顾性分析2014年1月至2018年12月收治的12例中枢神经系统类鼻疽病的临床资料,总结临床特点。结果12例中,10例为农民;8例有2型糖尿病病史。12例均有高热,静脉血中性粒细胞百分比、C反应蛋白、降钙素原升高。10例合并有肺部受累。12例中,脑脓肿4例,硬脑膜下脓肿2例,急性脑脊髓膜炎6例;12例在培养分离出类鼻疽伯克霍尔德菌前均未能确诊。手术清除颅内局限性病灶为有效治疗方法。碳青霉烯类为有效抗生素。确诊后6个月随访:死亡4例,其中急性脑脊髓膜炎3例,脑脓肿1例;6例遗留功能障碍;仅2例硬膜下脓肿完全康复。结论中枢神经系统类鼻疽病病情凶险,极易误诊,预后差。早期诊断、及时有效缓解颅内压增高、尽早足量应用敏感抗生素,以及控制好基础疾病是治疗成功的关键。Objective To analyze the clinical characteristics of central nervous system melioidosis(CNS-MD)in order to guide its clinical diagnosis and treatment.Methods The clinical data of 12 patients of with CNS-MD treated from January,2014 to December,2018 were retrospectively analyzed,and the clinical characteristics were summarized.Results Of 12 patients,10 were farmers;8 patients had type 2 diabetes.All the 12 patients had high fever,and the percentage of peripheral blood neutrophils,the serum levels of C-reactive protein and procalcitonin were elevated.The lungs were involved in 10 patients.Of 12 patients,4 had brain abscesses,2 subdural abscesses,and 6 acute meningococcal meningitis.All the 12 patients were not diagnosed until Burkholderia pseudomallei was cultured.Surgical removal of localized intracranial lesions was an effective treatment method.Carbapenems were effective antibiotics.The follow-up of 6 months after diagnosis showed that 4 patients died including 3 patients with acute meningitis and 1 with cerebral abscess,6 had residual dysfunction,and only 2 with subdural abscess were completely recovered.Conclusions The CNS-MD is extremely dangerous and easily misdiagnosed,and has a poor prognosis.Early diagnosis,timely and effective relief of increased intracranial pressure,early and full application of sensitive antibiotics,and control of underlying diseases are the keys to successful treatment of CNS-MD.

关 键 词：中枢神经系统感染 类鼻疽病 类鼻疽伯克霍尔德菌 临床特征 

分 类 号：R742[医药卫生—神经病学与精神病学]