人型支原体致中枢神经系统感染2例并文献复习  

Central nervous system infection caused by Mycoplasma hominis: report of two cases and literature review

作　　者：常红 李文军[3] 黄淼渺 戴飘飘 邱宇[3] 张新 秦晓华 CHANG Hong;LI Wenjun;HUANG Miaomiao;DAI Piaopiao;QIU Yu;ZHANG Xin;QIN Xiaohua(Institute of Antibiotics,Huashan Hospital,Fudan University,Key Laboratory of Clinical Pharmacology of Antibiotics,National Health Commission of the People's Republic of China,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院抗生素研究所,国家卫健委抗生素临床药理重点实验室,上海200040 [2]复旦大学附属华山医院神经外科,上海200040 [3]绵阳市第三人民医院(四川省精神卫生中心)呼吸与危重症医学科

出　　处：《中国感染与化疗杂志》2023年第1期61-66,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的 了解人型支原体致中枢神经系统感染的临床特征,提高临床医生对人型支原体致中枢神经系统感染的认识。方法 对2例人型支原体致脑膜炎患者的临床表现、实验室检查结果、治疗及预后进行分析,并以“Mycoplasma hominis”和“encephalitis”或“cerebritis”或“cephalitis”或“neuraxitis”或“meningitis”或“brain abscess”或“cranial infection”为关键词,检索1950—2022年PubMed数据库关于人型支原体致中枢神经系统感染的文献,筛选并总结分析人型支原体致中枢神经系统感染患者的临床资料。结果 该2例患者分别为脑出血、脑肿瘤术后,以发热、头痛为主要表现,血常规示白细胞升高,脑脊液压力和白细胞升高、糖降低,提示中枢神经系统感染,均予以经验性抗细菌治疗后,感染控制不佳,行脑脊液宏基因组二代测序(mNGS)检测为人型支原体,诊断为人型支原体脑膜炎,给予目标治疗后患者好转。通过文献复习并结合此2例患者,共26例患者,其中男16例、女10例,年龄6~79岁,平均年龄(35.5±19.0)岁;诊断为脑脓肿12例,脑膜炎9例,以及脑室炎、脊髓脓肿、硬膜下脓肿、脑室腹腔分流感染、眼眶脓肿各1例;感染前均有颅脑创伤或手术病史;主要临床表现有:发热、意识障碍(昏迷、谵妄)、头痛、偏瘫、恶心呕吐等;分别通过脑脊液及脓液标本的培养、16S rDNA、m NGS、免疫荧光试验、VITEK-MS、PCR、生长抑制试验等方法确诊,平均确诊时间为20.4 d;予以目标性抗感染治疗,治愈23例,死亡2例,复发1例。结论 人型支原体是颅脑创伤、手术后患者中枢神经系统感染的潜在病原体,m NGS的使用有助于明确病原诊断,及早进行目标治疗,改善患者预后。Objective To understand the clinical characteristics of central nervous system infection caused by Mycoplasma hominis and improve clinicians’ awareness of such an infection in clinical practice. Methods The clinical manifestations, laboratory test results, treatment and outcome were reviewed and analyzed in 2 patients with meningitis caused by M. hominis. PubMed database was searched using the strategy of “Mycoplasma hominis” AND “encephalitis” OR “cerebritis” OR “cephalitis” OR “neuraxitis”OR “meningitis” OR “brain abscess” OR “cranial infection” from 1950 to 2022 to find out the patients with central nervous system infection caused by M. hominis. The clinical data of the identified patients were analyzed and summarized. Results The two patients in this report underwent surgery due to cerebral hemorrhage and brain tumor, respectively. The main symptoms and laboratory test results included fever and headache, leukocytosis, elevated pressure of cerebrospinal fluid(CSF), and elevated leukocytes and reduced glucose in CSF. All these evidence supports the diagnosis of central nervous system infection. Empiric antibiotic treatment was initiated but failed to control infection. M. hominis was detected by metagenomic next-generation sequencing(m NGS) in cerebrospinal fluid. M. hominis meningitis was diagnosed. The patients recovered after targeted treatment. Literature search identified 24 cases of central nervous system infection caused by M. hominis. In summary, the 26 cases(including the two in this report) included 16 males and 10 females(6 to 79, and average 35.5 ± 19.0 years of age). The diagnosis included brain abscess in 12 cases, meningitis in 9 cases, ventriculiti, spinal cord abscess, subdural abscess, ventriculoperitoneal shunt infection, and orbital abscess in 1 case each. All patients had a history of craniocerebral trauma or surgery before infection. The main clinical manifestations were fever, consciousness disorder(coma, delirium), headache, hemiplegia, nausea and vomi

关 键 词：人型支原体 脑膜炎 中枢神经系统感染 宏基因组二代测序 

分 类 号：R518.9[医药卫生—内科学]