应用糖皮质激素患者合并粪类圆线虫感染1例并文献回顾  

Strongyloidiasis infection after glucocorticoid usage:a case report and literature review

作　　者：龙康霞 刘海俊 周健儿 韦秀宁[2] Long Kangxia;Liu Haijun;Zhou Jian'er;Wei Xiuning(Department of Rheumatology,Panyu Central Hospital,Guangzhou 511400,Guangdong,China;Department of Rheumatology,Sun Yat-Sen Memorial Hospital,Guangzhou 510120,Guangdong,China)

机构地区：[1]广州市番禺区中心医院风湿免疫科,广东广州511400 [2]中山大学孙逸仙纪念医院风湿免疫科,广东广州510120

出　　处：《中国医学前沿杂志（电子版）》2022年第8期59-64,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的提高临床医生对应用糖皮质激素患者感染粪类圆线虫继发细菌性脑膜炎的认识。方法报道1例于2018年12月5日在广州市番禺区中心医院内分泌科住院,因长期应用糖皮质激素患者感染粪类圆线虫继发细菌性脑膜炎患者的临床资料,并在Pubmed数据库以“Strongyloidiasis”或“Strongyloides”和“bacterial meningitis”或“meningitis”检索,对1980年1月至2022年3月相关英文文献进行复习。结果患者男,59岁,因“恶心、呕吐1d”入院。既往因类风湿关节炎长期使用糖皮质激素。入院检查提示低钠、低氯,皮质醇节律低下,予激素替代治疗过程中出现发热、意识不清,脑膜刺激征阳性,脑脊液培养阳性,抗感染等治疗效果欠佳。后大便检查找到粪类圆线虫卵,明确诊断为粪类圆线虫感染继发细菌性脑膜炎,抗感染同时加用抗寄生虫治疗,好转出院。检索文献,共10例应用糖皮质激素患者合并粪类圆线虫感染继发细菌性脑膜炎病例,通过找到虫卵或虫体确诊,8例脑脊液培养阳性,以肠科杆菌为主,5例合并机会致病菌感染,其中8例死亡。结论应用糖皮质激素患者感染粪类圆线虫易继发细菌性脑膜炎,脑脊液培养以肠科杆菌为主,易合并机会致病菌感染,死亡率高,需要抗感染同时抗寄生虫治疗,并适当延长抗寄生虫治疗时间。Objective To improve clinicians’understanding of bacterial meningitis subsequent to strongyloidiasis infection after long-term usage of glucocorticoid.Method To analyze a case of hyperinfective strongylaidiasis with bacterial meningitis.who was admitted to the Department of Rheumatology at Panyu Central Hospital on December 5th 2018.The relevant literatures were reviewed in Pubmed from January 1980 to March 2022.ResultA 59-year-old man was admitted because of nausea and vomiting for one day.Long-term of glucocorticoid was prescribed for rheumatoid arthritis.Hyponatremia,hypochloremia,disorder of cortisol circadian rhythm were shown on admission day.During hydrocortisone treatment,the patient presented with fever and unconsciousness,positive meningeal irritation sign,and cerebrospinal fluid(CSF)culture showed bacterial infection.Treatment of sensitive antibiotic was noneffective.S.stercoralis eggs was found in the stool.Bacterial meningitis secondary to strongyloidiasis was finally diagnosed.Clinical symptoms were improved after albendazole prescription and discharge successfully.10 cases of strongyloidiasis infection secondary to glucocorticoid usage were identified from the database.Cases were diagnosed with strongyloidiasis according to positive finding of S.stercoralis eggs or larvae in stool sample,gastroscope biopsy or bronchoalveolar lavage fluid.Among them,8 cases were positive for CSF culture,mainly Escherichia coli.5 cases were complicated with opportunist infection[fugus,cytomegalovirus(CMV)],and 8 cases were died.Conclusion Long-term usage of glucocorticoid increase the risk of bacterial meningitis subsequent to strongyloidiasis infection.CSF culture mainly show Escherichia coli.Antiparasitic therapy is needed combined with antibiotics and prolonged duration of treatment is recommended.

关 键 词：粪类圆线虫 糖皮质激素 细菌性脑膜炎 

分 类 号：R532.1[医药卫生—内科学]