人型支原体,众所周知的新生儿感染的原因,已被报道为成人泌尿生殖道感染的病原体;然而,中枢神经系统(CNS)感染很少见。我们在这里报道了中国首例人源性脑膜炎,一名71岁男性脑出血的神经外科治疗后。
我们描述了一名71岁的男子,他在神经外科治疗后患上了人型支原体脑膜炎,并成功地接受了为期2周的阿奇霉素和米诺环素联合治疗。尽管延迟治疗,因为脑脊液(CSF)的革兰氏染色没有产生可见的生物。诊断需要对CSF培养的分离物进行16SrDNA测序分析。人型支原体中枢神经系统感染的文献复习产生了19例(脑脓肿13例,3脑膜炎,脊髓脓肿各1例,硬膜下积脓各1例)。在所有情况下,诊断延迟和初始治疗失败都很明显。通过适当的微生物测试,抗生素治疗(5天至12周),多种手术干预措施,几乎所有患者都立即好转。
我们的患者发现和文献综述,强调了人源M.hominis的致病潜力以及罕见传染病所带来的挑战,特别是对诊断资源有限的发展中国家实验室而言。
Mycoplasma hominis, a well known cause of neonatal infection, has been reported as a pathogen in urogenital infections in adults; however, central nervous system (CNS) infections are rare. We report here the first case of M. hominis meningitis in China, post neurosurgical treatment for an intracerebral haemorrhage in a 71-year-old male.
We describe a 71-year-old man who developed M. hominis meningitis after neurosurgical treatment and was successfully treated with combined azithromycin and minocycline therapy of 2 weeks duration, despite delayed treatment because the Gram stain of cerebrospinal fluid (CSF) yielded no visible organisms. The diagnosis required 16S rDNA sequencing analysis of the cultured isolate from CSF. Literature
review of M. hominis CNS infections yielded 19 cases (13 instances of brain abscess, 3 of meningitis, 1 spinal cord abscess and 1 subdural empyema each). Delay in diagnosis and initial treatment failure was evident in all cases. With appropriate microbiological testing, antibiotic therapy (ranging from 5 days to 12 weeks) and often, multiple surgical interventions, almost all the patients improved immediately.
Both our patient findings and the literature
review, highlighted the pathogenic potential of M. hominis together with the challenges prompted by rare infectious diseases in particular for developing countries laboratories with limited diagnostic resources.