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伤寒沙门氏菌脑膜炎是罕见的疾病,多并发于伤寒病。本文报道1例成人原发性伤寒沙门氏菌脑膜炎。患者女性,24岁,发热、呕吐、头痛2天,无肠道症状。两年前曾作过伤寒预防接种,既往史无殊。体检:患者呈发热面容,心血管及呼吸系统均正常,腹部平、软,无压痛,无肝脾肿大。神志清,表情淡漠,颈项强直,克氏征阳性。其他神经系统包括眼底检查结果均属正常。白细胞计数17200/毫米~3,中性92%,淋巴6%,单核2%。脑脊液混浊,压力增高。脑脊液沉淀物染色镜检有许多固紫染色阴性杆菌,培养分离到伤寒沙门氏菌。而在起病第1至第2周的血液和粪便培养中未见有沙门氏菌生长。从起病后的第4、12、20及50天分别作肥达氏凝集试验,均与以前的伤寒预防接种的效价一致,未发现抗体滴度增高。
Salmonella typhimurium meningitis is a rare disease that is complicated by typhoid fever. This article reports a case of adult primary Salmonella typhi meningitis. Female patient, 24 years old, fever, vomiting, headache for 2 days, no bowel symptoms. Typhoid fever vaccination was made two years ago with no previous history. Physical examination: patients showed a hot face, cardiovascular and respiratory system are normal, abdominal flat, soft, no tenderness, no hepatosplenomegaly. Consciousness, expression of indifference, neck stiffness, Kirschner sign positive. Other nervous system including fundus examination results are normal. WBC count 17200 / mm ~ 3, 92% neutral, lymph 6%, mononuclear 2%. Cerebrospinal fluid cloudy, increased pressure. Cerebrospinal fluid sediment staining microscopy stained with a number of purple-negative bacilli, isolated from Salmonella typhi. Salmonella growth was not seen in the blood and feces cultures during the first week to the second week of onset. From the onset of the 4th, 12th, 20th and 50th days, respectively, for the Wadda agglutination test, were consistent with the previous typhoid vaccination titer, did not find the antibody titer increased.