新型冠状病毒感染合并李斯特菌脑膜炎1例并文献复习

doi:10.3969/j.issn.1004-583X.2024.04.009

摘要/Abstract

摘要：

目的提高对新型冠状病毒及单核细胞增多性李斯特菌(Listeria monocytogenes,LM)脑膜炎的认识,增强临床医生对李斯特菌病的诊治水平。方法回顾性分析新型冠状病毒感染合并LM脑膜炎患者1例,并进行文献学习。结果患者女性,77岁,以发热、头痛起病,合并新型冠状病毒感染,通过脑脊液培养及血培养检查,确诊为LM脑膜炎,经过足量青霉素联合庆大霉素、后改为美罗培南抗感染治疗,临床症状缓解,病情得到有效控制。结论针对新型冠状病毒感染和免疫功能紊乱的患者,积极治疗基础病,改善机体免疫状态是关键,一旦确诊李斯特菌病,足量、足疗程应用敏感抗生素对改善预后至关重要。

关键词: 脑膜炎, 利斯特菌性, 单核细胞增多性李斯特菌, 新型冠状病毒感染, 抗菌药

Abstract:

Objective To improve the understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and Listeria monocytogenes (LM) meningitis, thus strengthening the level of diagnosis and treatment of Listeria infections in clinicians. Methods A case of SARS-CoV-2 infection combined with LM meningitis was retrospectively analyzed, and the literatures were reviewed. Results A 77-year-old femal patient started with fever and headache, combined with SARS-CoV-2 infection, was diagnosed as LM meningitis through cerebrospinal fluid culture and blood culture. After sufficient penicillin combined with gentamicin, and meropenem subsequent for anti-infection treatment, the patient's clinical symptoms were significantly relieved, and the disease was effectively controlled. Conclusion For patients with infection of SARS-CoV-2 and immune disorders, curative care of basic diseases and improvement of immune status are the key. Once listeriosis is diagnosed, the application of sufficient and adequate treatment period of sensitive antibiotics is crucial to improve the prognosis.

Key words: meningitis, Listeria, Listeria monocytogenes, COVID-19, anti-bacterial agents

中图分类号:

只丙娣, 刘英, 刘莹, 张复波, 李俊峰. 新型冠状病毒感染合并李斯特菌脑膜炎1例并文献复习[J]. 临床荟萃, 2024, 39(4): 347-351.

Zhi Bingdi, Liu Ying, Liu Ying, Zhang Fubo, Li Junfeng. SARS-CoV-2 infection combined with Listeria meningitis: A case report and literature review[J]. Clinical Focus, 2024, 39(4): 347-351.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.04.009

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I4/347

图/表 3

表1 脑脊液检测

Tab.1 Examination of cerebrospinal fluid

项目	入院第5 d	入院第12 d	入院第32 d
压力(mmH₂O)	85	50	135
颜色	黄色	淡粉色	无色
透明度	微混	浑浊	透明
凝块	无	无	无
新鲜红细胞百分比	90%	90%	0
小淋巴细胞百分比	84%	72%	95%
大淋巴细胞百分比	0	0	0
一般单核细胞百分比	1%	2%	3%
激活单核细胞百分比	0	0	0
中性粒细胞百分比	4%	5%	0
其他细胞百分比	异形淋巴细胞11%	异形淋巴细胞16%,浆细胞5%	浆细胞2%
白细胞计数(个/mm³)	865	513	30
红细胞计数(个/mm³)	50	18 000	5
氯化物(mmol/L)	109.80	106.20	118.90
乳酸脱氢酶(U/L)	585.60	181.10	72.40
脑脊液蛋白(mg/dl)	683.30	758.60	136.60
葡萄糖(mmol/L)	3.81	5.70	2.98
腺苷脱氨酶(U/L)	33.50	21.10	4.00
墨汁染色	-	/	-
革兰染色	未查见细菌	/	未查见细菌
抗酸染色	未发现抗酸杆菌	/	未发现抗酸杆菌
其他	-	/	-
免疫球蛋白G(mg/dl)	79.3	132.0	24.5
细菌培养	LM	无细菌生长	无细菌生长
新型隐球菌荚膜抗原	-	/	-
基因检测(宏基因二代测序)	LM	未查见细菌	LM,巨细胞病毒,EB病毒

图1 入院第5 d头颅增强MRI 双侧额颞顶叶柔脑膜及双侧侧脑室室管膜增厚,增强后可见强化信号,脑沟裂池增宽加深,间质源性脑水肿

Fig.1 Dynamic contrast-enhanced magnetic resonance imaging of the head on the 5th day of admission The leptomeninges of the bilateral frontotemporal and parietal lobes and the ependymal membrane of the bilateral lateral ventricles were thickened. Enhanced signals were detected after contract enhancement. The sulcal fissures and cisterns were widened and deepened. Interstitial brain edema was observed

图2 入院第15 d头颅增强MRI 双侧额颞顶叶柔脑膜及双侧侧脑室室管膜较前变薄,增强后强化信号较前减低,间质源性脑水肿较前好转

Fig.2 Dynamic contrast-enhanced magnetic resonance imaging of the head on the 15th day of admission The leptomeninges of the bilateral frontotemporal and parietal lobes and the ependymal membrane of the bilateral lateral ventricles were thinner than before, the enhanced signal was lower than before, and interstitial brain edema was better

参考文献 22

[1]	Hernandez-Milian A, Payeras-Cifre A. What is new in listeriosis?[J]. Biomed Res Int, 2014, 2014:358051.
[2]	Jones D. Foodborne listeriosis[J]. Lancet, 1990, 336(8724):1171-1174. pmid: 1978036
[3]	Martins IS, Faria FC, Miguel MA, et al. A cluster of Listeria monocytogenes infections in hospitalized adults[J]. Am J Infect Control, 2010, 38(9):e31-6.
[4]	Swaminathan B, Gerner-Smidt P. The epidemiology of human listeriosis[J]. Microbes Infect, 2007, 9(10):1236-1243. doi: 10.1016/j.micinf.2007.05.011 pmid: 17720602
[5]	America CDC. Can Listeria infection be serious?[EB/OL].[2023-8-23]. https://www.cdc.gov/listeria/faq.html
[6]	Goulet V, Hebert M, Hedberg C, et al. Incidence of listeriosis and related mortality among groups at risk of acquiring listeriosis[J]. Clin Infect Dis, 2012, 54(5):652-660. doi: 10.1093/cid/cir902 pmid: 22157172
[7]	Feng Y, Wu S, Varma JK, et al. Systematic review of human listeriosis in China, 1964-2010[J]. Trop Med Int Health, 2013, 18(10):1248-1256. doi: 10.1111/tmi.12173 pmid: 24016031
[8]	Kayaaslan BU, Akinci E, Bilen S, et al. Listerial rhombencephalitis in an immunocompetent young adult[J]. Int J Infect Dis, 2009, 13(2):e65-7.
[9]	Freitag NE, Port GC, Miner MD. Listeria monocytogenes -from saprophyte to intracellular pathogen[J]. Nat Rev Microbiol, 2009, 7(9):623-628. doi: 10.1038/nrmicro2171 pmid: 19648949
[10]	Goulet V, King LA, Vaillant V, et al. What is the incubation period for listeriosis?[J] BMC Infect Dis, 2013, 13:11. doi: 10.1186/1471-2334-13-11 pmid: 23305174
[11]	Zheng M, Gao Y, Wang G, et al. Functional exhaustion of antiviral lymphocytes in COVID-19 patients[J]. Cell Mol Immunol, 2020, 17(5):533-535. doi: 10.1038/s41423-020-0402-2 pmid: 32203188
[12]	陶哲影, 刘嘉琳. COVID-19发病机制的免疫特征[J]. 中华微生物学和免疫学杂志, 2020, 40(9):649-653.
[13]	陈惠丽, 刘曦, 黄珊凤, 等. 新型冠状病毒肺炎患者外周血T淋巴细胞亚群变化[J]. 中华实验和临床感染病杂志(电子版), 2021, 15(2):99-104.
[14]	任敏睿, 刘凤凤, 孙军玲, 等. 新型冠状病毒肺炎重症及死亡的影响因素研究进展[J]. 国际病毒学杂志, 2020, 27(6):516-520.
[15]	Bohmwald K, Gálvez NMS, Ríos M, et al. Neurologic alterations due to respiratory virus infections[J]. Front Cell Neurosci, 2018, 12:386. doi: 10.3389/fncel.2018.00386 pmid: 30416428
[16]	Martínez-Mármol R, Giordano-Santini R, Kaulich E, et al. SARS-CoV-2 infection and viral fusogens cause neuronal and glial fusion that compromises neuronal activity[J]. Sci Adv, 2023, 9(23):eadg2248.
[17]	de Valk H, Jacquet C, Goulet V, et al. Surveillance of Listeria infections in Europe[J]. Euro Surveill, 2005, 10(10):251-255.
[18]	Goulet V, Marchetti P. Listeriosis in 225 non-pregnant patients in 1992: Clinical aspects and outcome in relation to predisposing conditions[J]. Scand J Infect Dis, 1996, 28(4):367-374. pmid: 8893400
[19]	Julián A, Jiménez A A, de Górgolas M, et al. Listeria monocytogenes infections in the adult. Clinical and microbiological issues of a changing disease[J]. Enferm Infecc Microbiol Clin, 2001, 19(7):297-303.
[20]	李晓芳, 金鑫, 史颖, 等. 单核细胞增生李斯特菌脑膜脑炎二例[J]. 中华医学杂志, 2021, 101(8):602-603.
[21]	辛子凯, 邹月丽, 范佳, 等. 脑脊液二代测序确诊中枢神经系统李斯特菌感染二例[J]. 中华医学杂志, 2019, 99(25):1989-1990.
[22]	彭芳, 李余霞, 王庆松, 等. 李斯特菌脑膜炎1例报告及文献复习[J]. 中风与神经疾病杂志, 2020, 37(6):558-560. doi: 10.19845/j.cnki.zfysjjbzz.2020.0396