背景:李斯特菌是一种食源性疾病,这在正常人群中很少流行;它主要发生在孕妇身上,新生儿,免疫缺陷患者,和老人。这种疾病在患者中的主要表现包括败血症,脑膜炎,etc,死亡率仍然很高,尽管脑膜炎的发作相对阴险。
方法:一名75岁男子出现发热1周,入院诊断和治疗肺部感染。接受抗感染治疗2周后,病情好转。然而,他出院后不久,他又发烧了,并逐渐出现各种神经症状,意识受损,脖子僵硬。此后,通过脑脊液宏基因组检测和血液培养,患者被诊断为单核细胞增生李斯特菌脑膜炎和败血症.病人在接受积极治疗后死亡,其中包括青霉素应用和侵入性呼吸支持。
结论:这个案例突出了早期识别和及时应用各种敏感抗生素的最终重要性,如青霉素,万古霉素,美罗培南,等。因此,对于不明原因发热的高危人群,多种血液培养,及时脑脊液检查,宏基因组检测技术可以帮助快速确认诊断,从而指导抗生素的正确应用,改善预后。
BACKGROUND: Listeria is a food-borne disease, which is rarely prevalent in the normal population; it mostly occurs in pregnant women, newborns, immunodeficiency patients, and the elderly. The main manifestations of this disease in patients include sepsis, meningitis, etc, and the mortality rate remains high, although the onset of meningitis is relatively insidious.
METHODS: A 75-year-old man presented with a fever for 1 wk and was admitted to the hospital for diagnosis and management of a lung infection. His condition improved after receiving anti-infective treatment for 2 wk. However, soon after he was discharged from the hospital, he developed fever again, and gradually developed various neurological symptoms, impaired consciousness, and stiff neck. Thereafter, through the cerebrospinal fluid metagenomic testing and blood culture, the patient was diagnosed with Listeria monocytogenes meningitis and sepsis. The patient died after being given active treatment, which included penicillin application and invasive respiratory support.
CONCLUSIONS: This
case highlights the ultimate importance of early identification and timely application of the various sensitive antibiotics, such as penicillin, vancomycin, meropenem, etc. Therefore, for high-risk populations with unknown causes of fever, multiple blood cultures, timely cerebrospinal fluid examination, and metagenomic detection technology can assist in confirming the diagnosis quickly, thereby guiding the proper application of antibiotics and improving the prognosis.