脓血性脑脊液的个案报道

doi:10.5246/jcps.2021.06.042

中国药学(英文版) ›› 2021, Vol. 30 ›› Issue (6): 538-542.DOI: 10.5246/jcps.2021.06.042

脓血性脑脊液的个案报道

周祎, 王军^*(), 高凤娟^*()

南京大学医学院附属鼓楼医院急诊科, 江苏南京 210008

收稿日期:2020-11-18 修回日期:2020-12-26 接受日期:2021-02-03 出版日期:2021-06-29 发布日期:2021-06-29
通讯作者: 王军, 高凤娟
作者简介:
+ Tel.: +86-25-83106666-60184, E-mail: wangjunnjglyy@163.com
+ Tel.: +86-25-83106666-60184, E-mail: gaofj79@163.com

A 61-year-old man with bloody purulent cerebrospinal fluid

Yi Zhou, Jun Wang^*(), Fengjuan Gao^*()

Department of Emergency Medicine, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing 210008, China

Received:2020-11-18 Revised:2020-12-26 Accepted:2021-02-03 Online:2021-06-29 Published:2021-06-29
Contact: Jun Wang, Fengjuan Gao

摘要/Abstract

摘要：

金黄色葡萄球菌脑膜炎(SAM)是一种相对罕见但严重的疾病, 仅占细菌性脑膜炎比例的1%–9%。在本报道中, 我们介绍了一位61岁的老人, 他的脑脊液外观为脓血性, 脑脊液化验显示白细胞计数和蛋白定量极高, 细菌培养确定为金黄色葡萄球菌脑膜炎。病程中并发了感染性休克, 急性呼吸衰竭和急性肾功能衰竭。经验性抗生素治疗对他无效, 因此我们同时使用了多达5种抗生素。之后患者的临床症状、脑脊液指标、炎症指标、呼吸功能和肾功能均明显好转。出院6个月后的随访显示患者的神经功能恢复良好。

关键词: 金黄色葡萄球菌脑膜炎, 感染性休克, 脑脊液, 抗生素

Abstract:

Staphylococcus aureus meningitis (SAM) is a relatively uncommon but serious disease, accounting for only 1%–9% of cases of bacterial meningitis. In this report, we described a 61-year-old man, whose appearance of CSF was bloody and purulent. CSF test showed extremely elevated WBC count and protein quantification. Bacterial culture demonstrated SAM. Complications included septic shock, acute respiratory failure, and renal failure. Empiric antibiotic treatment was not effective for him. Therefore, we prescribed up to five types of antibiotics. We found that the clinical symptoms, CSF indicators, inflammatory markers, respiratory and renal function got better. The nerve function comparatively recovered well after 6 months of follow-up.

Key words: Staphylococcus aureus meningitis, Septic shock, Cerebrospinal fluid, Antibiotics

Supporting:

Table 1. Changes in inflammatory markers and renal function parameters

Table 2. Changes in CSF indicators

周祎, 王军, 高凤娟. 脓血性脑脊液的个案报道[J]. 中国药学(英文版), 2021, 30(6): 538-542.

Yi Zhou, Jun Wang, Fengjuan Gao. A 61-year-old man with bloody purulent cerebrospinal fluid[J]. Journal of Chinese Pharmaceutical Sciences, 2021, 30(6): 538-542.

图/表 3

Figure 1. Images obtained during a lumbar puncture. (A) Day 1, bloody purulent CSF; (B) Day 33, comparatively clear CSF; (C) Day 46, limpid CSF.

Figure 2. CT scan of the chest. (A) Inflammation in the lower lobe of the right lung; (B) Inflammation was completely absorbed.

Figure 3. Cranial magnetic resonance imaging showed hydrocephalus and limited diffuse speckle in the left centrum?semiovale and the posterior horn of the right lateral ventricle. (A) T1-weighted imaging; (B) T2-weighted imaging; (C) Diffusion-weighted imaging; (D) FLAIR sequence.

参考文献 11

[1]	Durand, M.L.; Calderwood, S.B.; Weber, D.J.; Miller, S.I.; Southwick, F.S.; Caviness, V.S. Jr, Swartz, M.N. Acute bacterial meningitis in adults: a review of 493 episodes. N. Engl. J. Med. 1993, 328, 21–28.
[2]	Bijlsma, M.W.; Brouwer, M.C.; Kasanmoentalib, E.S.; Kloek, A.T.; Lucas, M.J.; Tanck, M.W.; van der Ende, A.; van de Beek, D. Community-acquired bacterial meningitis in adults in the Netherlands, 2006-14: a prospective cohort study. Lancet Infect. Dis. 2016, 16, 339–347.
[3]	Pedersen, M.; Benfield, T.L.; Skinhoej, P.; Jensen, A.G. Haematogenous Staphylococcus aureus meningitis. A 10-year nationwide study of 96 consecutive cases. BMC Infect. Dis. 2006, 6, 49.
[4]	Brouwer, M.C.; Keizerweerd, G.D.; Brouwer, M.C.; Keizerweerd, G.D.; De Gans, J.; Spanjaard, L.; van de Beek, D. Community acquired Staphylococcus aureus meningitis in adults. Scand. J. Infect. Dis. 2009, 41, 375–377.
[5]	Aguilar, J.; Urday-Cornejo, V.; Donabedian, S.; Perri, M.; Tibbetts, R.; Zervos, M. Staphylococcus aureus meningitis: case series and literature review. Medicine (Baltimore). 2010, 89, 117–125.
[6]	Tunkel, A.R.; Hartman, B.J.; Kaplan, S.L.; Kaufman, B.A.; Roos, K.L.; Scheld, W.M.; Whitley, R.J. Practice guidelines for the management of bacterial meningitis. Clin. Infect. Dis. 2004, 39, 1267–1284.
[7]	Tunkel, A.R.; Hasbun, R.; Bhimraj, A.; Byers, K.; Kaplan, S.L.; Scheld, W.M.; van de Beek, D.; Bleck, T.P.; Garton, H.J.L.; Zunt, J.R. 2017 infectious diseases society of america’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin. Infect. Dis. 2017, 64, e34–e65.
[8]	van de Beek, D.; Cabellos, C.; Dzupova, O.; Esposito, S.; Klein, M.; Kloek, A.T.; Leib, S.L.; Mourvillier, B.; Ostergaard, C.; Pagliano, P.; Pfister, H.W.; Read, R.C.; Sipahi, O.R.; Brouwer, M.C.; ESCMID Study Group for Infections of the Brain (ESGIB) ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin. Microbiol. Infect. 2016, 22, S37–S62.
[9]	van de Beek, D.; Drake, J.M.; Tunkel, A.R. Nosocomial bacterial meningitis. N. Engl. J. Med. 2010, 362, 146–154.
[10]	Liu, C.; Bayer, A.; Cosgrove, S.E.; Daum, R.S.; Fridkin, S.K.; Gorwitz, R.J.; Kaplan, S.L.; Karchmer, A.W.; Levine, D.P.; Murray, B.E.; J Rybak, M.; Talan, D.A.; Chambers, H.F.; America, I.D.S.O. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin. Infect. Dis. 2011, 52, e18–e55.
[11]	Pintado, V.; Meseguer, M.; Fortún, J.; Cobo, J.; Navas, E.; Quereda, C.; Corral, I.; Moreno, S. Clinical study of 44 cases of staphylococcus aureus meningitis. Eur. J. Clin. Microbiol. Infect. Dis. 2002, 21, 864–868.

[1]	李晓辉, 王倩, 刘琛楠, 韩江雪, 刘思含, 刘天俊, 王倩, 关艳, 肖春玲, 王潇, 刘忆霜. 一种新型KPC-2抑制剂: PHT427[J]. 中国药学(英文版), 2023, 32(12): 989-997.
[2]	杨雁芳, 张伊楠, 张友波, 杨秀伟. 液质联用法测定吴茱萸碱、吴茱萸次碱、去氢吴茱萸碱在大鼠脑脊液和脑组织中的分布[J]. 中国药学(英文版), 2022, 31(1): 13-22.
[3]	王倩, 刘琛楠, 韩江雪, 刘思含, 肖春玲, 关艳, 李兴华, 王颖, 王潇, 蒙建州, 甘茂罗, 刘忆霜. 一种新型NDM-1抑制剂: (–)-表儿茶素没食子酸酯[J]. 中国药学(英文版), 2021, 30(9): 716-724.
[4]	谢程欣, 王维, 黄戈, 金鑫, 王成龙, 尹东. 中国药剂师干预减少骨科不合理用药的现状[J]. 中国药学(英文版), 2020, 29(6): 375-382.
[5]	金媛媛, 刘娟娟, 冯晓洲, 李亚东, 汪康游, 孙婉, 田喜凤, 杨兆勇. 细菌转位酶MraY及其抑制剂的研究进展[J]. 中国药学(英文版), 2015, 24(3): 137-147.
[6]	侯凤琴, 孙新婷, 王贵强. 成人粪白细胞1-14/HPF的非血便急性感染性腹泻患者病原及抗生素应用的探讨[J]. 中国药学(英文版), 2015, 24(2): 121-127.
[7]	王明娟, 郑超, 胡昌勤^*, 金少鸿, Hoogmartens Jos, Van Schepdael Ann, Adams Erwin. 乙酰螺旋霉素组分分析中色谱柱的理性选择方法探讨[J]. , 2011, 20(6): 572-577.
[8]	朱健萍, 张慧文, 胡昌勤^*. 毛细管电泳分析β-内酰胺抗生素杂质最佳分离模式的选择[J]. , 2010, 19(4): 285-292.
[9]	侯凤琴, 孙新婷, 王贵强^*. 教学医院不合理应用抗菌药物治疗成人急性感染性腹泻调查[J]. , 2010, 19(3): 229-234.
[10]	曹颖^1,2, 杨巍¹, 林晓雯¹, 邵宏^1*. 药学干预对基层医院抗生素使用结构的影响[J]. , 2009, 18(3): 283-286.
[11]	许明哲, 马仕洪, 胡昌勤^*. 凝胶过滤色谱和Bradford法测定发酵类抗生素中蛋白残留量[J]. , 2004, 13(4): 262-266.
[12]	张如鸿, 雷嘉川, 李荣凌, 罗顺德, 何文, 蔡鸿生, 周延安. 神经外科手术病人血及脑脊液中左氟沙星药动学的研究[J]. , 2000, 9(2): 100-103.
[13]	彭瑶, 包定元, 王龙贵, 刘晓梅, 籍秀娟. 思文霉素对胞外DNA拓扑异构酶介导产生的断裂和松驰反应的影响[J]. , 1994, 3(2): 120-125.

脓血性脑脊液的个案报道

A 61-year-old man with bloody purulent cerebrospinal fluid

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 3

参考文献 11

相关文章 13

编辑推荐

Metrics

本文评价