人类免疫缺陷病毒感染合并肺炎链球菌脑膜炎——附1例报告  

Human immunodeficiency virus infection with Streptococcus pneumoniae meningitis:1 case report

作　　者：马梦泽 喜贺热[1] 陈媛[1] 苏丹 Ma Mengze;Xi Here;Chen Yuan;Su Dan(Department of Clinical Laboratory,Bayannur Hospital,Bayannur 015000,Inner Mongolia Autonomous Region,China;Department of Clinical Laboratory,Dengkou County People's Hospital of Bayannur,Bayannur 015000,Inner Mongolia Autonomous Region,China)

机构地区：[1]巴彦淖尔市医院检验科,内蒙古自治区巴彦淖尔015000 [2]巴彦淖尔市磴口县人民医院检验科,内蒙古自治区巴彦淖尔015200

出　　处：《实用检验医师杂志》2023年第2期212-214,共3页Chinese Journal of Clinical Pathologist

摘　　要：目的报告1例人类免疫缺陷病毒(HIV)感染合并肺炎链球菌脑膜炎患者的诊疗过程,分析和总结相关实验室检查结果的规律。方法2021年1月18日某三甲医院收治1例HIV合并肺炎链球菌脑膜炎患者,通过传染筛查、脑脊液生化常规检查、细菌鉴定及脑脊液培养,查找病因并确诊。结果患者为30岁女性,因“2 d前无明显诱因出现头痛、发热,精神恍惚”入院。检测结果可见HIV阳性,脑脊液常规可见乳白色、浑浊,潘氏试验(+++),白细胞计数(WBC)为112.0×10^(6)/L↑,多形核细胞比例为83%,单核细胞比例为17%,脑脊液蛋白为4590 mg/L↑,氯化物为116 mmol/L↓,葡萄糖为0.1 mmol/L↓;脑脊液培养结果为肺炎链球菌。患者诊断为HIV感染合并肺炎链球菌脑膜炎,最终患者放弃治疗出院。结论感染HIV的患者被肺炎链球菌侵袭的可能性比普通人群高25%~50%,脑脊液检查是化脓性脑膜炎诊断的“金标准”,在感染性疾病的最终确诊过程中病原学诊断依据更重要。Objective To report the diagnosis and treatment of a case of human immunodeficiency virus(HIV)infected patient with Streptococcus pneumoniae meningitis,analyze and summarize the regularity of related laboratory data.Methods On January 18,2021,a tertiary A hospital admitted a case of HIV infection with Streptococcus pneumoniae meningitis.Through infection screening,routine biochemical examination of cerebrospinal fluid,bacterial identification and cerebrospinal fluid culture,the cause was found and confirmed.Results The patient was a 30-year-old female,admitted to the hospital because"there was no obvious cause of headache and fever two days ago,and there was a trance phenomenon".The test results showed that HIV was positive,the cerebrospinal fluid was milky white and turbid,Pan's test(+++),white blood cell count(WBC)was 112.0×10^(6)/L↑,polymorphonuclear cells ratio was 83%,monocyte ratio was 17%,cerebrospinal fluid protein was 4590 mg/L↑,chloride was 116 mmol/L↓,glucose was 0.1 mmol/L↓,and the cerebrospinal fluid was cultured as Streptococcus pneumoniae.The patient was diagnosed with HIV infection complicated with Streptococcus pneumoniae meningitis,and finally gave up treatment and was discharged.Conclusions The probability of HIV infected patients invaded by Streptococcus pneumoniae is 25%-50%higher than that of ordinary people.Cerebrospinal fluid examination is the"gold standard"for diagnosis of purulent meningitis.In final diagnosis of infectious diseases,pathogenic diagnosis is more important.

关 键 词：人类免疫缺陷病毒 肺炎链球菌 化脓性脑膜炎 脑脊液检查 

分 类 号：R512.91[医药卫生—内科学] R742.9[医药卫生—临床医学] R446.14