单核细胞增生李斯特菌脑膜炎的临床特点及抗感染治疗

摘要

Objective To describe clinical characteristics and anti-infective treatment of Listeria monocytogenes(L.monocytogenes)meningitis.Methods Clinical manifestations and cerebrospinal fluid(CSF)examination results of 6 patients with L.monocytogenes meningitis in a hospital were analyzed retrospectively.Evaluation methods were developed according to relevant guidelines and literatures,anti-infective treatment and prognosis of patients with L.monocytogenes meningitis were evaluated.Results Two of 4 adults with L.monocytogenes meningitis had triad of fever,stiff neck,and altered mental status,the mean white blood cell count(WBC)of the initial CSF detection was 997×106/L,CSF/blood glucose ratio was 0.32,CSF protein was 1.43g/L;the other 2 neonates had fever,epilepsy,and hyponatremia,WBC were both>1 000×106/L,CSF protein were both>1 g/L,CSF/blood glucose ratio was<0.5.Of 6 patients,none were treated with appropriate initial empiric anti-infection therapy,confirmed by CSF or blood culture,5 cases were treated with ampicillin anti-infective therapy,1 used compound sulfamethoxazole due to penicillin allergy;1 neonate died,1 elderly patient was with moderate disability,the remaining 4 cases were all recovered and discharged from hospital.Conclusion Clinical manifestations and CSF findings of L.monocytogenes meningitis are not different from other purulent meningitis,commonly used antimicrobial agents for the treatment of purulent meningitis are not sensitive to L.monocytogenes,which should be paid attention in clinic.%目的 描述单核细胞增生李斯特菌(Lm)脑膜炎病例的临床特点和抗感染治疗情况.方法 回顾性分析某院6例Lm脑膜炎患者的临床表现和脑脊液检查结果.根据相关指南和文献制定评价方法,评价Lm脑膜炎患者抗感染治疗及转归情况.结果 4例 Lm脑膜炎成年患者中2例出现发热、颈强直和精神状态改变的三联征,首次脑脊液(CSF)的平均白细胞计数为997×106/L、脑脊液/血液葡萄糖比值为0.32、蛋白为1.43 g/L;2例新生儿出现发热,并发癫痫、低钠血症,其CSF的白细胞计数均>1 000×106/L,CSF蛋白均>1 g/L,CSF/血液葡萄糖比值<0.5.6例患者当中无1例使用适当的初始经验性抗感染治疗,经CSF或血培养确诊,5例使用氨苄西林抗感染,1例患者因青霉素过敏而使用复方磺胺甲口恶唑;1例新生儿死亡,1例老年患者中度残疾,其余4例均康复出院.结论 Lm脑膜炎临床表现、CSF指标与其他化脓性脑膜炎无明显差别,而临床常用于治疗化脓性脑膜炎的抗菌药物又对Lm不敏感,需引起临床警觉.