脑脊液高通量测序确诊的中枢神经系统厌氧菌感染8例临床观察  

Clinical observation of 8 cases with central nervous system anaerobic infection diagnosed by metagenomic next-generation sequencing of cerebrospinal fluid

作　　者：韩晓晨 刘若雪 林鑫 何俊瑛[1] 卜晖[1] Han Xiaochen;Liu Ruoxue;Lin Xin;He Junying;Bu Hui(Department of Neurology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院神经内科,石家庄050000

出　　处：《中华医学杂志》2022年第20期1533-1536,共4页National Medical Journal of China

摘　　要：本研究总结2019年6月至2021年6月就诊于河北医科大学第二医院的8例中枢神经系统厌氧菌感染患者的病例特点。在8例患者中,7例以头痛、发热为首发症状,1例以左侧肢体无力为首发症状。4例患者既往糖尿病病史,其中1例患者发病前有拔牙史;1例患者既往鼻窦炎病史;1例患者发病前有拔牙史;2例患者存在慢性广泛性牙周炎或根尖周围炎。5例患者头颅核磁(MRI)显示颅内和(或)脑膜异常强化,1例患者头颅电子计算机断层扫描(CT)显示全脑组织肿胀。经治疗后,4例患者病情好转,1例病情加重,3例死亡。厌氧菌感染可发生于全身各部位:中枢神经系统、口腔、头颈部、胸部、腹部、骨盆、皮肤和软组织等。一般认为厌氧菌较少造成中枢神经系统感染,因此通常不进行脑脊液厌氧菌培养,且厌氧菌培养受多种因素影响,较难得到阳性结果。高通量测序可根据DNA和(或)RNA序列从样本中识别多种病原体(病毒、细菌、真菌或寄生虫),在诊断中枢神经系统厌氧菌感染方面具有优势。及时经验性抗菌治疗对于患者预后至关重要。The current study summarized the clinical characteristics of 8 patients with central nervous system anaerobic infections who visited the Second Hospital of Hebei Medical University from June 2019 to June 2021.Among the 8 patients,7 cases had headache and fever as the first symptoms,and 1 case had left-sided limb weakness as the first symptom.Four patients had a previous history of diabetes(1 patient had a history of tooth extraction before the onset of the disease),1 patient had a previous history of sinusitis,1 patient had a history of tooth extraction before the onset of the disease,and 2 patients had chronic extensive periodontitis or periapical periodontitis.Five cases showed abnormal intracranial and/or meningeal enhancement on cranial magnetic resonance imaging(MRI),and 1 case showed swelling of the whole brain tissue on cranial computed tomography(CT).After treatment,symptoms of 4 cases were improved,symptoms of 1 case were aggravated,and 3 cases died.Anaerobic infections can occur in various parts of the body:the central nervous system,oral cavity,head and neck,chest,abdomen,pelvis,skin and soft tissues.It is generally believed that anaerobic bacteria rarely cause central nervous system infection,therefore,anaerobic culture of cerebrospinal fluid is usually not performed.Moreover,anaerobic culture is affected by many factors,and thus it is difficult to obtain positive results.Metagenomic next-generation sequencing can identify multiple pathogens(viral,bacterial,fungal,or parasitic)from samples based on DNA and/or RNA sequences and has advantages in diagnosing anaerobic infections of the central nervous system.Prompt empirical antimicrobial therapy is essential for the prognosis of the patients.

关 键 词：中枢神经系统感染 宏基因组 高通量核苷酸测序 厌氧 药物治疗 

分 类 号：R741[医药卫生—神经病学与精神病学]