无乳链球菌感染通常见于特定人群,包括新生儿,孕妇,和老人。这些病人还不成熟,较低,免疫系统衰退,这使得它们更容易受到感染。典型的无乳链球菌感染表现为蜂窝织炎,菌血症,心内膜炎,脑膜炎,脑室炎(脑膜炎的罕见并发症),骨髓炎。在极少数情况下,患者可以表现出两种或两种以上的典型感染表现。作者介绍了一例48岁女性,既往有甲状腺功能减退和慢性背痛病史,因精神状态改变而被送往急诊科。患者在一次家庭聚会后出现恶心和呕吐的前两天,其次是枕骨头痛和躁动。一到达急诊室,患者不服从命令,昏昏欲睡。初步检查显示Brudzinski和Kernig体征呈阳性。病人是心动过速,Tachypneic,和高血压。初始计算机断层扫描(CT)头无造影剂对任何急性病理均为阴性。咨询了神经病学,在床边做了腰椎穿刺,这对于32cmH2O的开口压力升高是显著的。病人最初开始服用头孢曲松,氨苄青霉素,万古霉素,阿昔洛韦,还有地塞米松.磁共振成像(MRI)的大脑有和无对比显示急性脑室炎,轻度软脑膜增强,和右后冠状放射状急性腔隙性梗塞。脑膜炎小组,BioFire(BioFire诊断,盐湖城,UT),无乳链球菌呈阳性,患者被降级为头孢曲松。脑脊液和血培养恢复无乳链球菌阳性。经胸超声心动图显示心内膜炎阴性,但是经食管超声心动图对二尖瓣后叶(P1/P2扇贝)的0.7×0.4cm移动回波密度具有重要意义。重复血液培养,额外的脑脊液分析,传染性检查仍然是阴性的。咨询心脏病学并建议药物治疗。患者在临床上有所改善,继续使用头孢曲松,出院后完成了为期6周的门诊随访评估治疗.这个病例描述了心内膜炎的罕见表现,脑膜炎,和脑室炎无乳链球菌感染,以及在处理复杂疾病时需要明确的治疗算法。
Streptococcus agalactiae infection is typically seen in specific populations, including neonates, pregnant women, and the elderly. These patients have immature, lower, and waning immune systems, which makes them more susceptible to infections. Typical S. agalactiae infections manifest as cellulitis, bacteremia, endocarditis, meningitis, ventriculitis (a rare complication of meningitis), and osteomyelitis. In rare cases, a patient can present with two or more of these typical infection manifestations. The authors present a
case of a 48-year-old female with a past medical history of hypothyroidism and chronic back pain who presented to the emergency department with altered mental status. The patient developed nausea and vomiting two days prior to presentation after a family gathering, followed by occipital headache and agitation. On arrival at the emergency department, the patient did not follow commands and was drowsy. The initial examination showed positive for Brudzinski and Kernig signs. The patient was tachycardic, tachypneic, and hypertensive. Initial computed tomography (CT) head without contrast was negative for any acute pathology. Neurology was consulted, and a bedside lumbar puncture was performed, which was significant for elevated opening pressure of 32 cm H2O. The patient was initially started on ceftriaxone, ampicillin, vancomycin, acyclovir, and dexamethasone. Magnetic resonance imaging (MRI) of the brain with and without contrast showed acute ventriculitis, mild leptomeningeal enhancement, and a right posterior corona radiata acute lacunar infarct. Meningitis panel, BioFire (BioFire Diagnostics, Salt Lake City, UT), was positive for S. agalactiae, and the patient was de-escalated to ceftriaxone. Cerebrospinal fluid and blood cultures returned positive for S. agalactiae. A transthoracic echocardiogram was negative for endocarditis, but a transesophageal echocardiogram was significant for a 0.7 × 0.4 cm mobile echodensity attached to the posterior leaflet of the mitral valve (P1/P2 scallop). Repeat blood cultures, additional cerebrospinal fluid analysis, and infectious workup remained negative. Cardiology was consulted and recommended medical treatment. The patient improved clinically, continued ceftriaxone, and was discharged to complete a total of six weeks of treatment with outpatient follow-up evaluations. This
case depicts a rare presentation of endocarditis, meningitis, and ventriculitis S. agalactiae infection and the need for a definite treatment algorithm in the management of complicated conditions such as the one presented.