PDF(Pubmed)
Abstract：
BACKGROUND: Bacillus cereus infections in immunocompetent patients are uncommon and mainly observed in fragile patients. It can cause lethal infections with multiple organ dysfunction syndrome (MODS). However, a patient presenting as venous sinus thrombosis and survival without sequela has not been reported.
METHODS: A 20-year-old previously healthy male developed gastroenteritis after a meal, followed by fever, convulsions, and severe disturbance of consciousness. The patient had significant leukocytosis with a mildly elevated D-dimer, creatinine level, and respiratory failure. The CT(computed tomography) revealed fatal brain edema and subarachnoid hemorrhage. Previous blood culture in a local hospital revealed B. cereus, which was confirmed by mNGS(metagenomic next-generation sequencing) using blood and urine in our hospital. Accordingly, B. cereus sepsis with MODS were considered. Later, cerebral venous sinus thrombosis was proved. After anti-infection (linezolid 0.6 g, Q12h; and meropenem 1.0 g, Q8h), anti-coagulant (enoxaparin 6000U, Q12h), and other symptomatic treatments, the patient recovered completely without sequela at the 6-month follow-up.
CONCLUSIONS: This case suggests that in immunocompetent adults, there is still a risk of infection with B. cereus, causing severe MODS. Special attention should be paid to venous sinus thrombosis and subarachnoid hemorrhage in such cases, while, anti-coagulant is essential therapy.
METHODS: A 20-year-old previously healthy male developed gastroenteritis after a meal, followed by fever, convulsions, and severe disturbance of consciousness. The patient had significant leukocytosis with a mildly elevated D-dimer, creatinine level, and respiratory failure. The CT(computed tomography) revealed fatal brain edema and subarachnoid hemorrhage. Previous blood culture in a local hospital revealed B. cereus, which was confirmed by mNGS(metagenomic next-generation sequencing) using blood and urine in our hospital. Accordingly, B. cereus sepsis with MODS were considered. Later, cerebral venous sinus thrombosis was proved. After anti-infection (linezolid 0.6 g, Q12h; and meropenem 1.0 g, Q8h), anti-coagulant (enoxaparin 6000U, Q12h), and other symptomatic treatments, the patient recovered completely without sequela at the 6-month follow-up.
CONCLUSIONS: This case suggests that in immunocompetent adults, there is still a risk of infection with B. cereus, causing severe MODS. Special attention should be paid to venous sinus thrombosis and subarachnoid hemorrhage in such cases, while, anti-coagulant is essential therapy.
摘要：
背景：免疫活性患者的蜡样芽孢杆菌感染并不常见，主要在脆性患者中观察到。它可以引起多器官功能障碍综合征（MODS）的致命感染。然而,1例表现为静脉窦血栓形成和无后遗症存活的患者尚未报告.
方法：一名20岁以前健康的男性在餐后出现胃肠炎，接着是发烧,抽搐,和严重的意识障碍。患者有明显的白细胞增多，D-二聚体轻度升高，肌酐水平,和呼吸衰竭。CT（计算机断层扫描）显示致命的脑水肿和蛛网膜下腔出血。先前在当地医院的血液培养显示蜡状芽孢杆菌，mNGS（宏基因组下一代测序）在我们医院使用血液和尿液证实了这一点。因此，考虑了具有MODS的蜡样芽孢杆菌败血症。稍后，脑静脉窦血栓形成。抗感染后（利奈唑胺0.6g，Q12h；美罗培南1.0g，Q8h),抗凝剂(依诺肝素6000U,Q12h),和其他对症治疗，在6个月的随访中,患者完全康复,无后遗症.
结论：该病例表明，在有免疫能力的成年人中，仍然有感染蜡样芽孢杆菌的风险，导致严重的MODS。在这种情况下，应特别注意静脉窦血栓形成和蛛网膜下腔出血，while,抗凝是必不可少的治疗方法。
方法：一名20岁以前健康的男性在餐后出现胃肠炎，接着是发烧,抽搐,和严重的意识障碍。患者有明显的白细胞增多，D-二聚体轻度升高，肌酐水平,和呼吸衰竭。CT（计算机断层扫描）显示致命的脑水肿和蛛网膜下腔出血。先前在当地医院的血液培养显示蜡状芽孢杆菌，mNGS（宏基因组下一代测序）在我们医院使用血液和尿液证实了这一点。因此，考虑了具有MODS的蜡样芽孢杆菌败血症。稍后，脑静脉窦血栓形成。抗感染后（利奈唑胺0.6g，Q12h；美罗培南1.0g，Q8h),抗凝剂(依诺肝素6000U,Q12h),和其他对症治疗，在6个月的随访中,患者完全康复,无后遗症.
结论：该病例表明，在有免疫能力的成年人中，仍然有感染蜡样芽孢杆菌的风险，导致严重的MODS。在这种情况下，应特别注意静脉窦血栓形成和蛛网膜下腔出血，while,抗凝是必不可少的治疗方法。
