高毒力肺炎克雷伯菌致重症颅内感染1例  

Severe intracranial infection caused by hypervirulent Klebsiella pneumoniae:a case report

作　　者：张萍[1] 许峰[1] 梁奇明[1] 连立飞[1] 王芙蓉 Zhang Ping;Xu Feng;Liang Qiming;Lian Lifei;Wang Furong(Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030

出　　处：《中华神经科杂志》2022年第3期229-233,共5页Chinese Journal of Neurology

基　　金：国家重点研发计划(2020YFC2006001);国家自然科学基金面上项目(81974218);湖北省科技厅重点研发计划(2020BCA089)。

摘　　要：高毒力肺炎克雷伯菌(HvKP)是肺炎克雷伯菌的新型变种,具有毒力强、易播散的特点,主要引起肝脓肿合并多部位侵袭性感染,包括眼、肺和中枢神经系统等,致死率极高。文中报道1例由HvKP引起的重症颅内感染患者。该例患者为44岁男性,急性起病,有发热、头痛伴意识障碍,迅速进展为颅高压、呼吸衰竭。脑脊液提示化脓性感染,细菌培养提示为肺炎克雷伯菌,除对氨苄西林耐药外,其他常用抗生素均敏感。头颅磁共振成像示双侧额顶颞叶、右侧半卵圆中心及双侧辐射冠、基底节区、丘脑、岛叶多发异常信号,脑膜及室管膜强化增多,脑组织肿胀。患者在住院过程中又合并了泛耐药肺炎克雷伯菌血流感染,病情危重。经积极治疗,患者治愈出院,半年后随访预后良好,恢复社会功能。文中通过对该患者的临床资料和诊治经过进行报道并回顾文献,为临床对该病的诊治提供参考。Hypervirulent Klebsiella pneumoniae(HvKP)is a new variant of Klebsiella pneumoniae.It is characterized by strong virulence and easy dissemination.It mainly causes liver abscess with multiple invasive infections,including eye,lung and central nervous system,with a high fatality rate.A case of severe intracranial infection caused by HvKP was reported.The patient was a 44-year-old formerly healthy man.He had acute onset of fever,headache,and disturbance of consciousness,which rapidly progressed to intracranial hypertension and respiratory failure.Cerebrospinal fluid examination suggested purulent infection,and bacterial culture suggested Klebsiella pneumoniae,which was sensitive to other commonly used antibiotics except ampicillin.Brain magnetic resonance imaging showed multiple abnormal signals in bilateral frontal,parietal and temporal lobes,right centrum semiovale,bilateral corona radiata,basal ganglia,thalamus and insula,as well as enhancement of meningeal and ependymal membrane,and swelling of brain tissue.During hospitalization,the patient developed a blood stream infection of pan-drug-resistant Klebsiella pneumoniae and was in critical condition.After aggressive treatment,the patient was cured and discharged from the hospital.After half a year follow-up,his prognosis was good and his social function was restored.The clinical data,diagnosis and treatment of the patient were reported and the literature was reviewed to provide clinical reference for the disease.

关 键 词：肺炎克雷伯菌 脑膜炎 细菌性 脑脓肿 耐碳青霉烯类肺炎克雷伯菌 

分 类 号：R742.9[医药卫生—神经病学与精神病学]