单核细胞增生性李斯特菌致中枢神经系统感染12例临床分析  

Central nervous system infection caused by Listeria monocytogenes:Clinical analysis of 12 cases

作　　者：丁雪梅 殷翔 崔俐[1] Ding Xuemei;Yin Xiang;Cui Li(Department of Neurology,the First Hospital of Jilin University,Changchun 130031,China)

机构地区：[1]吉林大学第一医院神经内科,长春130031

出　　处：《中华临床感染病杂志》2024年第5期383-388,共6页Chinese Journal of Clinical Infectious Diseases

基　　金：国家自然科学基金(82071351)。

摘　　要：目的总结中枢神经系统感染单核细胞增生性李斯特菌(Listeria monocytogenes,LM)患者的临床特点,以期为该病的临床诊治提供帮助。方法收集2020年1月至2023年12月吉林大学第一医院神经内科收治的12例中枢神经系统感染LM患者临床资料,回顾性分析患者的临床表现、实验室检查、影像学检查、治疗及预后等特点。采用SPSS 27.0软件对数据进行分析。结果所有患者均有发热,头痛10例(10/12),颈部僵硬10例(10/12)。合并局灶性神经功能缺损症状和精神行为异常各2例(2/12)。7例(7/12)合并自身免疫性疾病并接受免疫抑制治疗。实验室检查结果显示,所有患者脑脊液蛋白质、白细胞计数均升高,8例(8/12)氯化物水平降低,3例(3/12)葡萄糖水平降低。10例行脑脊液宏基因组二代测序(metagenomic next-generation sequencing,mNGS)均检出LM。进行血和脑脊液细菌培养各11例,阳性分别为5例(5/11)和2例(2/11)。影像学检查:3例增强核磁共振成像显示脑膜强化,1例丘脑结节样强化,2例发现单发脑脓肿,2例并发脑积水,1例表现为菱脑炎。所有患者从发病到明确诊断时间为5.00(4.25,6.75)d。所有患者在明确诊断后启动了一线治疗(氨苄西林+庆大霉素),4例患者后续启动二线抗菌治疗(复方磺胺甲噁唑和/或美罗培南)。12例患者中,治愈2例,临床好转9例,1例放弃治疗死亡。3个月后随访,9例临床好转中3例遗留神经系统后遗症。结论中枢神经系统感染LM的临床表现及影像学多种多样,易被误诊;脑脊液mNGS较传统方法检出率更高;临床经验抗菌治疗应覆盖LM。Objective To analyze the clinical features of patients with Listeria monocytogenes(LM)infection in the central nervous system.Methods The clinical data of 12 patients with central nervous system LM infection admitted to the Department of Neurology of the First Hospital of Jilin University from January 2020 to December 2023 were retrospectively analyzed,in terms of the clinical manifestations,laboratory results,imaging findings,treatment and prognosis.SPSS 27.0 software was used to analyse the data.Results The clinical manifestations were fever(12/12),headache(10/12)and neck stiffness(10/12).There were 2 cases with focal neurological deficit symptoms and mental behavior abnormalities respectively.Seven patients(7/12)had autoimmune diseases and received immunosuppressive therapy.Laboratory tests showed that in cerebrospinal fluid(CSF),protein and leukocytes levels were elevated in all patients,chloride levels were decreased in 8 cases(8/12),and glucose levels were decreased in 3 cases(3/12).The metagenomic next-generation sequencing(mNGS)test was performed in CSF samples of 10 patients,and all showed positive results for LM.The bacterial culture was performed in 11 cases and showed positive results for 5 blood samples and 2 CSF samples,respectively.Eleven patients underwent enhanced MRI scan,which showed meningeal enhancement in 3 cases and thalamic nodular enhancement in 1 case.In addition,MRI also showed single brain abscess in 2 cases,hydrocephalus in 2 cases,and rhombencephalitis in 1 case.The time from onset to definitive diagnosis was 5.00(4.25,6.75)days.All patients were treated with a first-line regimen(ampicillin+gentamicin)after being definitively diagnosed,4 patients subsequently received second-line antimicrobial therapy(cotrimoxazole and/or meropenem).Of the 12 patients,2 cases were cured,1 case was dead against medical advice,and 9 cases were clinically improved,of whom 3 had neurological sequelae 3 months after discharge.Conclusions The clinical manifestations and imaging of Listeria monocytogenes in

关 键 词：中枢神经系统感染 单核细胞增生性李斯特菌 宏基因组二代测序 脑脓肿 临床特点 

分 类 号：R74[医药卫生—神经病学与精神病学]