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目的:探讨重症中枢神经系统李斯特菌感染的病因、发病机制、临床表现、影像学特点、治疗及预后。方法:回顾中日友好医院神经内科2014年10月~2015年6月期间收治的2例重症中枢李斯特菌感染患者的临床资料,分析其临床特点、实验室检查、治疗及预后,并复习相关文献。结果:神经系统李斯特菌感染主要累及免疫抑制的患者,但其中脑干脑炎的患者常为没有易感因素的年轻人。中枢神经系统李斯特菌感染常引起脑膜炎、脑炎或者脑干脑炎。影像学检查异常率不高,主要表现为脑干脑炎、脑室扩张等。目前没有中枢神经系统李斯特菌感染的最佳治疗方案和治疗时限,早期联合使用抗菌素被认为可能有较好的效果。结论:重症中枢神经系统李斯特菌感染病情进展迅速,死亡率高,需要尽早诊治,从而改善预后。
Objective: To investigate the etiology, pathogenesis, clinical manifestations, imaging features, treatment and prognosis of Listeria monocytogenes in severe central nervous system. Methods: The clinical data of 2 patients with severe Listeria monocytogenes who were admitted to Department of Neurology, China-Japan Friendship Hospital from October 2014 to June 2015 were retrospectively analyzed, and their clinical characteristics, laboratory tests, treatment and prognosis were reviewed. literature. RESULTS: Nervous system Listeria infections predominantly affected immunosuppressed patients, but patients with encephalitogenic encephalitis were often young adults without predisposing factors. Listeria infection in the central nervous system often causes meningitis, encephalitis or encephalitis. Imaging abnormalities is not high, mainly for brainstem encephalitis, ventricular dilatation. There is currently no optimal treatment for Listeria monocytogenes infection in the CNS and the duration of treatment. An early combination of antibiotics is considered as potentially effective. Conclusion: The disease progression of Listeria monocytogenes in the central nervous system is rapid and the mortality rate is high. The diagnosis and treatment of Listeria monocytogenes is needed as soon as possible to improve the prognosis.