肺炎克雷伯菌脑脓肿四例  

Klebsiella pneumoniae brain abscess:4 cases report

作　　者：冯雪丹[1] 于莎莎 张玉婧 陈剑华[1] 高煜 马红梅[1] 王向波[2] Feng Xuedan;Yu Shasha;Zhang Yujing;Chen Jianhua;Gao Yu;Ma Hongmei;Wang Xiangbo(Department of Neurology,the Beijing Fengtai Youanmen Hospital,Beijing 100069,China)

机构地区：[1]北京丰台右安门医院神经内科,北京100069 [2]首都医科大学宣武医院神经内科

出　　处：《脑与神经疾病杂志》2021年第4期232-236,共5页Journal of Brain and Nervous Diseases

基　　金：北京市丰台区卫生健康委基金项目(2017-83)。

摘　　要：目的描述肺炎克雷伯菌脑脓肿的临床特征、治疗及预后,为临床诊治该疾病提供参考。方法分析4例肺炎克雷伯菌脑脓肿患者的临床资料,并复习相关文献。结果本组4例患者均为男性。例1~例3主要临床表现为发热、头痛、记忆力减退、睡眠增多、癫痫发作、脑膜刺激征,伴或不伴神经病理征阳性。例4表现为发热、四肢瘫、眼球运动障碍、右侧霍纳综合征及病理征阳性。既往创伤史3例,隐源性脑脓肿1例。4例患者均行脑脊液宏基因组测序(metagenomic next generation sequencing,mNGS)技术检测为肺炎克雷伯菌感染。头颅MRI增强扫描提示病变环形强化2例,多发团块状强化1例、不规则强化1例。4例DWI检查均为高信号,1例颅脑CT提示颅内积气。所有患者均采用保守治疗,预后良好。结论本组肺炎克雷伯菌脑脓肿临床表现多不典型,易误诊。mNGS技术对脑脓肿的早期诊断有极其重要的价值。及时启动以美罗培南为基础的敏感抗生素治疗是决定预后的关键。objective To describe the clinical characteristics,treatment and prognosis of klebsiella pneumoniae(KP)brain abscess,and provide reference for clinical diagnosis and treatment.Methods The clinical data of 4 patients with KP brain abscess were retrospectively analyzed,and the related literatures were reviewed.Result All the 4 patients were male.The main clinical manifestations of case 1 to 3 included fever,headache,memory loss,increased sleep,seizures,meningeal irritation,with or without neuropathologic signs.Case 4 showed fever,quadriplegia,ocular dyskinesia,right Horner’s syndrome and neuropathologic syndrome.3 cases had a history of trauma and 1 case was cryptogenic.4 patients were diagnosed as KP infection by cerebrospinal fluid Metagenomic next generation sequencing(mNGS)technique.Head enhanced MRI scan showed circular enhancement in 2 cases,multiple mass enhancement in 1 case and irregular enhancement in 1 case.MRI-DWI showed high signal in all 4 cases and CT showed intracranial pneumatosis in 1 case.All patients were treated by conservative treatment and achieved good prognosis.Conclusion The clinical manifestations of KP brain abscess are not typical and it is easy to be misdiagnosed.mNGS technique plays a key role in the early diagnosis of brain abscess.Timely initiation of sensitive antibiotic therapy based on meropenem is the key to determine the prognosis.

关 键 词：脑脓肿 肺炎克雷伯菌 mNGS 

分 类 号：R742[医药卫生—神经病学与精神病学]