洛菲氏不动杆菌感染性多发鼻窦炎导致鼻窦沟通脑脓肿1例  

One case of sinus-communicating brain abscess caused by Acinetobacter lwoffii-induced infectious multiple sinusitis of the paranasal sinuses

作　　者：王邦向 秦德芳[1] 霍泳林 张泽舜[1] 马丁[1] WANG Bang-xiang;QIN De-fang;HUO Yong-lin;ZHANG Ze-shun;MA Ding(Department of Neurosurgery,Zhuhai Hospital,Guangdong Provincial Hospital of Traditional Chniese Medicine,Zhuhai 519000,China)

机构地区：[1]广东省中医院珠海医院神经外科,广东珠海519000

出　　处：《中国临床神经外科杂志》2024年第4期254-256,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：脑脓肿多因邻近组织感染扩散导致。洛菲氏不动杆菌是一种需氧的革兰氏阴性杆菌,定植于口咽部、皮肤、会阴部等,为一种机会性致病菌,在人体免疫力低下时引起免疫系统受损并导致感染。洛菲氏不动杆菌导致鼻窦沟通脑脓肿临床罕见。本文报道1例洛菲氏不动杆菌感染性多发鼻窦炎继发导致鼻窦沟通脑脓肿,24岁男性,因突发头痛半个月入院,入院血常规、血清CRP和降钙素原未见异常;脑脊液常规、生化、细菌及真菌培养未见异常;头颅CT、MRI检查考虑左侧额叶多发脓肿,左侧上颌窦和右侧蝶窦囊肿;脑脊液病原微生物检测DNA、RNA检测显示洛菲不动杆菌。给予万古霉素、美罗培南、奥硝唑治疗1周后,复查头颅CT示颅内低密度灶减少。完善术前准备后,行经鼻内镜下左侧鼻窦病损切除+左侧上颌窦、筛窦、额窦切开术。术后1个月复查头部CT及增强MRI示左额叶多发脑脓肿吸收、减少。术后3个月电话随访头痛明显好转。这提示临床上怀疑脑脓肿时,可行CT及MRI检查,以明确诊断,并经验性给予抗生素治疗。当培养不能发现病原菌时,可行基因检测增加检出率。Brain abscesses are most often caused by the spread of infection from neighbouring tissues.Fusobacterium lophi is an aerobic Gramnegative bacillus that colonizes the oropharnx,skin,and perineum,and is an opportunistic pathogen that causes damage to the immune system and leads to infection when the body is immunocompromised.It is rare for Fusobacterium lophi to cause a sinus-communicating brain abscess.This paper reports a case of sinus-communicating brain abscess secondary to Fusobacterium lophi infectous multiple sinusitis,a 24-year-old male,who was admitted to our hospital because of sudden headache for half a month,and there were no abnormalities in blood routine,serum CRP and PCT.Cerebrospinal fluid routine,biochemistry,bacterial and fungal culture showed no abnormality.Head CT and MRI considered multiple abscesses in the left frontal lobe,cysts in the left maxillary sinus and right pterygoid sinus.Cerebrospinal fluid pathogenic microorganism test shwoed Lofibacillus.Vancomucin,meropenem,and ornidazole were given for 1 week,and head CT showed a decrease in intracranial hypodense foci.After perfecting the preoperative preparations,endonasal endoscopic resection of the left sinus lesion,and incision of left maxillary sinus,sieve sinus and frontal lobe wer performed.One month after the operation,head CT and enhanced MRI showed that the multiple brain abscesses in the left frontal lobe were absorbed.The headache improved significantly 3 months after the operation.This suggests that when a brain abscess is suspected,CTand MRI should be performed to clarify the diagnosis,and emprical antibiotic traeatment should be given.When the culture can not find the pathogenic bacteria,genetic testing can be used to increase the detection rate.

关 键 词：脑脓肿 鼻窦沟通脑脓肿 洛菲氏不动杆菌 基因检测 

分 类 号：R742.7[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]