背景:诺卡氏菌病是由诺卡氏菌属的需氧革兰氏阳性菌引起的一种罕见感染。在免疫抑制患者中,诺卡氏菌引起的感染很常见。人类免疫缺陷病毒感染引起的免疫系统减弱,糖尿病,癌症,和其他疾病,如慢性肺病,肾功能衰竭,etc,是诺卡心症的主要危险因素。据报道,中枢神经系统(CNS)诺卡心症占所有疾病的约2%,并在15%至50%的全身性感染患者中出现。我们病例中的患者患有由白质诺卡氏菌感染引起的孤立的中枢神经系统诺卡氏菌病,一种罕见的重新分类的中枢神经系统诺卡氏菌病原体。
方法:我们在这里介绍一名54岁的中国男性,发烧和头痛持续15天,表现出阳性的脑膜刺激症状。磁共振成像显示侧脑室右侧三角脉络丛炎和弥漫性软脑膜脑膜炎累及双侧大脑半球,小脑半球,和脑干。患者在入院后48小时内通过下一代测序迅速诊断为中枢神经系统诺卡氏菌感染。同时,脑脊髓液培养中的诺卡氏菌阳性染色证实了诊断。患者给予甲氧苄啶-磺胺甲恶唑,三天后他的症状恢复了。
结论:在这种情况下,临床,放射学,和微生物学发现强调了怀疑诺卡氏菌为怀疑免疫功能不全的中枢神经系统炎症患者的潜在病原体的重要性。此外,下一代测序作为一种有效的检测方法,也极力推荐可疑中枢神经系统感染患者进行快速诊断和治疗.
BACKGROUND: Nocardiosis is an unusual infection caused by aerobic gram-positive bacteria in the genus
Nocardia. Infections resulting from
Nocardia species are frequent in immunosuppressive patients. Weakened immune systems caused by human immunodeficiency virus infection, diabetes, cancer, and other conditions such as chronic lung disease, renal failure, etc, are the main risk factors for nocardiosis. Central nervous system (CNS) nocardiosis has been reported to represent ~2% of all and to be present in 15% to 50% of patients with systemic infection. The patient in our case had an isolated CNS nocardiosis caused by
Nocardia terpenica infection, a rare reclassified
Nocardia pathogen of CNS nocardiosis.
METHODS: We here present a 54-year-old Chinese male with a fever and headache for 15 days who showed positive meningeal irritation signs. Magnetic resonance imaging showed the right trigone of the lateral ventricular choroid plexitis and diffused leptomeningeal meningitis involving the bilateral cerebral hemisphere, cerebellar hemisphere, and brain stem. The patient was quickly diagnosed with CNS
Nocardia infection by next-generation sequencing within 48 hours after admission. Meanwhile, the diagnosis was validated by Nocardia-positive staining in cerebral spinal fluid culturing. The patient was given trimethoprim-sulfamethoxazole, and his symptoms recovered after 3 days.
CONCLUSIONS: In this case, the clinical, radiological, and microbiological findings highlight the importance of suspecting Nocardia as the potential pathogen in patients with central nervous system inflammation of doubted immune incompetence. In addition, next-generation sequencing as an effective test is also highly recommended for suspicious CNS infection patients to perform a rapid diagnosis and treatment.