[1]邹文辉 李俊驹 黄垂学.中枢神经系统类鼻疽病的临床特点分析[J].中国临床神经外科杂志,2020,(03):144-146.[doi:10.13798/j.issn.1009-153X.2020.03.005]
 ZOU Wen-hui,LI Jun-ju,HUANG Chui-xue..Analysis of clinical characteristics of central nervous system melioidosis (report of 12 cases)[J].,2020,(03):144-146.[doi:10.13798/j.issn.1009-153X.2020.03.005]
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中枢神经系统类鼻疽病的临床特点分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年03期
页码:
144-146
栏目:
论著
出版日期:
2020-03-31

文章信息/Info

Title:
Analysis of clinical characteristics of central nervous system melioidosis (report of 12 cases)
文章编号:
1009-153X(2020)03-0144-03
作者:
邹文辉 李俊驹 黄垂学
570311 海口,海南省人民医院神经外科(邹文辉、李俊驹、黄垂学)
Author(s):
ZOU Wen-hui LI Jun-ju HUANG Chui-xue.
Department of Neurosurgery, Hainan General Hospital, Haikou 570311, China
关键词:
中枢神经系统感染类鼻疽病类鼻疽伯克霍尔德菌临床特征
Keywords:
Melioidosis Central nervous system infection Burkholderia pseudomallei Clinical characteristics
分类号:
R 742
DOI:
10.13798/j.issn.1009-153X.2020.03.005
文献标志码:
A
摘要:
目的 分析中枢神经系统类鼻疽病的临床特点,以指导临床诊治。方法 回顾性分析2014年1月至2018年12月收治的12例中枢神经系统类鼻疽病的临床资料,总结临床特点。结果 12例中,10例为农民;8例有2型糖尿病病史。12例均有高热,静脉血中性粒细胞百分比、C反应蛋白、降钙素原升高。10例合并有肺部受累。12例中,脑脓肿4例,硬脑膜下脓肿2例,急性脑脊髓膜炎6例;12例在培养分离出类鼻疽伯克霍尔德菌前均未能确诊。手术清除颅内局限性病灶为有效治疗方法。碳青霉烯类为有效抗生素。确诊后6个月随访:死亡4例,其中急性脑脊髓膜炎3例,脑脓肿1例;6例遗留功能障碍;仅2例硬膜下脓肿完全康复。结论 中枢神经系统类鼻疽病病情凶险,极易误诊,预后差。早期诊断、及时有效缓解颅内压增高、尽早足量应用敏感抗生素,以及控制好基础疾病是治疗成功的关键
Abstract:
Objective To analyze the clinical characteristics of central nervous system melioidosis (CNS-MD) in order to guide its clinical diagnosis and treatment. Methods The clinical data of 12 patients of with CNS-MD treated from January, 2014 to December, 2018 were retrospectively analyzed, and the clinical characteristics were summarized. Results Of 12 patients, 10 were farmers; 8 patients had type 2 diabetes. All the 12 patients had high fever, and the percentage of peripheral blood neutrophils, the serum levels of C-reactive protein and procalcitonin were elevated. The lungs were involved in 10 patients. Of 12 patients, 4 had brain abscesses, 2 subdural abscesses, and 6 acute meningococcal meningitis. All the 12 patients were not diagnosed until Burkholderia pseudomallei was cultured. Surgical removal of localized intracranial lesions was an effective treatment method. Carbapenems were effective antibiotics. The follow-up of 6 months after diagnosis showed that 4 patients died including 3 patients with acute meningitis and 1 with cerebral abscess, 6 had residual dysfunction, and only 2 with subdural abscess were completely recovered. Conclusions The CNS-MD is extremely dangerous and easily misdiagnosed, and has a poor prognosis. Early diagnosis, timely and effective relief of increased intracranial pressure, early and full application of sensitive antibiotics, and control of underlying diseases are the keys to successful treatment of CNS-MD.

参考文献/References:

[1] 谢 甜,王旭明,王 敏,等. 海南地区120例类鼻疽病临 床分型及特点[J]. 中国感染与化疗杂志,2018,18(4): 360-364.
[2] Limmathurotsakul D, Wongratanacheewin S, Teerawattana- sook N, et al. Increasing incidence of human melioidosis in Northeast Thailand [J]. Am J Trop Med Hyg, 2010, 82(6): 1113-1117.
[3] 李辉香,余正霞,陈本会. 一例类鼻疽急性败血症型患者 合并脓肿的护理体会[J]. 海南医学,2013,24(3):463- 464.
[4] 吴烨华,战跃福,俞安乐,等. 类鼻疽肝脓肿的临床特点分 析[J]. 中华肝脏病杂志,2017,25(10):775-777.
[5] 吴烨华,战跃福,俞安乐,等. 海南省26例类鼻疽脾脓肿 临床特点分析[J]. 中华传染病杂志,2017,35(1):27-30.
[6] 麦文慧,朱 雄,陈 海,等. 1例类鼻疽伯克霍尔德菌感 染复发睾丸脓肿的临床分析[J]. 第三军医大学学报, 2016,38(11):1226-1228.
[7] Wongwandee M, Linasmita P, Torres AG. Central nervous system melioidosis: a systematic review of individual participant data of case reports and case series [J]. PLoS Negl Trop Dis, 2019, 13(4): e7320.
[8] Li XY, Ke BX, Chen CN, et al. First co-infection case of melioidosis and Japanese encephalitis in China [J]. BMC Infect Dis, 2018, 18(1): 452.
[9] Madi D, Rai S V, Vidyalakshmi K, et al. Neurological meli- oidosis presenting as intracranial abscess [J]. Indian J Pathol Microbiol, 2016, 59(3): 417-419.
[10] Donahue MA, Newcomb G, Spinella S, et al. CNS Melioido- sis in a Traveler Returning from Cabo, Mexico [J]. Open Forum Infect Dis, 2019, 6(2): z5.
[11] 林 容,谢灿茂,陈 海,等. 类鼻疽病122例临床特征及 耐药性分析[J]. 广东医学,2011,32(17):2303-2304.
[12] 吴多荣,王旭明,黄 会,等. 10种抗菌药物对类鼻疽伯 克霍尔德菌体外抗菌活性探讨[J]. 中国热带医学,2014, 14(5):596-598.
[13] Koshy M, Jagannati M, Ralph R, et al. Clinical manifesta- tions, antimicrobial drug susceptibility patterns, and out- comes in Melioidosis cases, India [J]. Emerg Infect Dis, 2019, 25(2): 316-320.
[14] Amarasena HLP, Silva FHDS. Tilakaratna PMYI, et al. Me- lioidosis with a subdural collection-a case report [J]. BMC Infec Dis, 2019, 19(1): 143.

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备注/Memo

备注/Memo:
(2019-07-17收稿,2019-12-20修回)
更新日期/Last Update: 2020-03-10