背景:传统的诊断模型对于临床表现相似的中枢神经系统(CNS)疾病的病因诊断具有很大的挑战,特别是对罕见病原体的诊断。对病原菌进行快速、准确的鉴定对指导临床用药对策的选择具有重要意义。
方法:2020年8月22日,一名49岁的中国男性患者头痛两天,然后脑部的计算机断层扫描(CT)扫描显示蛛网膜下腔出血。随后,他接受了两次开颅手术和大约3周的住院。自9月20日起,患者在当地康复医院接受高压氧治疗约三周。然后患者发展为急性化脓性脑膜脑炎。在没有特定致病菌诊断的情况下,万古霉素(每12小时1克),头孢他啶(每8小时2克),甘露醇脱水(125毫升,每8小时),并根据脑脊液(CSF)检查和临床表现及时使用丙戊酸钠(0.4gtid)。住院期间脑脊液涂片和常规培养试验均为阴性。我们使用宏基因组下一代测序(mNGS)分析CSF快速准确的诊断,鉴定出人类疱疹病毒4型(EBV),棒状杆菌,木糖氧化无色杆菌,鲍曼不动杆菌,但测绘程度不高。然后,我们使用改进的方法-基于多重PCR的靶向基因测序平台(ptNGS)检测CSF样品,发现检测到的序列是皮氏不动杆菌(A.pittii)和表皮葡萄球菌。表皮葡萄球菌可能来自腰椎穿刺时的皮肤定植,所以它被排除在病因诊断之外。因此,我们高度怀疑这种情况下的病原体是A.pittii。经过大约三周的住院治疗,病人的症状缓解了。
结论:结论:经验用药前对病原体的鉴定非常重要。ptNGS可能是诊断病原体的有效方法。
BACKGROUND: The traditional diagnosis model has great challenges for the etiological diagnosis of the central nervous system (CNS) diseases with similar clinical manifestations, especially for the diagnosis of rare pathogens. It is very important to make rapid and accurate identification of pathogens for guiding clinical choices in administering countermeasures.
METHODS: On August 22, 2020, a 49 years old Chinese male patient had a headache for two days, and then the computed tomography (CT) scan of the brain showed subarachnoid hemorrhage. Subsequently, he underwent twice craniotomy and about 3 weeks of hospitalization. Since September 20, the patient was in the local rehabilitation hospital for hyperbaric oxygen therapy for about three weeks. Then the patient developed acute purulent meningoencephalitis. In the absence of diagnosis of specific pathogenic bacteria, vancomycin (1 g every 12 hours), ceftazidime (2 g every 8 hours), mannitol dehydration (125 mL, every 8 hours), and sodium valproate (0.4 g tid) was used timely according to cerebrospinal fluid (CSF) examination and clinical manifestations. CSF smear and routine culture test were negative during hospitalization. We used the metagenomic next-generation sequencing (mNGS) analysis of CSF for quick and accurate diagnosis, which identified human herpesvirus type 4 (EBV), Corynebacterium corynebacterium, Achromobacter xylose oxidation, and Acinetobacter baumannii, But the mapping degree was not high. Then, we used the modified method-multiplex PCR-based targeted gene sequencing platform (ptNGS) to detect CSF samples and found that the sequences detected were Acinetobacter pittii (A. pittii) and Staphylococcus epidermidis. S. epidermidis might come from skin colonization during lumbar puncture, so it was excluded from the etiological diagnosis. Therefore, we highly suspected that A. pittii was the pathogen in this
case. After about three weeks of hospitalization treatment, the patient\'s symptoms were relieved.
CONCLUSIONS: In conclusion, empirical medication before the identification of pathogens is very important. The ptNGS may be an effective method for the diagnosis of pathogens.