Long-term use of immunosuppressive agents induced listeria meningitis: A case report
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摘要: 本文介绍1例长期应用免疫抑制剂诱发李斯特菌脑膜炎患者的临床表现及其诊疗过程。该患者既往有哮喘病史，胸腺瘤术后8年，长期服用环孢素，2022年4月加用美卓乐，药物治疗导致免疫功能低下。入院后结合血培养、脑脊液培养和二代基因测序(nex tgenera-tionsequencing，NGS)结果确诊为化脓性脑膜炎(李斯特菌感染)，经我院神经内科会诊，结合患者高颅压、癫痫发作，给予加用甘露醇及德巴金对症治疗，病情控制后转至当地医院住院治疗10天后病情好转并出院。该患者的诊治过程提示李斯特菌脑膜炎虽较少见，但对于免疫功能低下者需警惕继发感染的可能，结合患者临床表现、血培养、腰穿及高通量测序结果对于明确诊断、治疗乃至控制病情至关重要。Abstract: This article describes the clinical presentation of a patient with listeria meningitis induced by long-term application of immunosuppressive drugs and the course of his treatment. The patient had a previous history of asthma, 8 years after thymoma surgery, and long-term cyclosporine, with the addition of Medrol in April 2022, and drug therapy resulting in immune deficiency. After admission, the diagnosis of septic meningitis(Listeria monocytogenes infection) was confirmed with blood culture, cerebrospinal fluid culture and second-generation gene sequencing(next generation sequencing, NGS) results. After consultation by our neurology department, the patient was given symptomatic treatment with mannitol and Depakene in combination with high cranial pressure and seizures, and his condition was controlled and transferred to a local hospital for 10 days after inpatient treatment he patient's condition improved and was discharged from the hospital. The diagnosis and treatment of this patient suggest that although listeria meningitis is rare, immunocompromised patients need to be alerted to the possibility of secondary infection, and the combination of clinical manifestations, blood culture, lumbar puncture and high-throughput sequencing results is crucial for definite diagnosis, treatment and even control of the disease.
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Key words:
- immunosuppression /
- listeria meningitis /
- blood culture /
- high-throughput sequencing
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表 1 脑脊液常规检查结果
检出指标 检出结果 单位 外观 淡黄色 透明度 微浑浊 凝固性 无凝块 潘氏试验 阳性 脑脊液白细胞 736.0 106/L 脑脊液红细胞 1 000.0 106/L 白细胞分类-单个核细胞 25 % 白细胞分类-多核细胞 75 % 
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表 2 脑脊液生化检查结果
检出指标 检出结果 单位 UCFP 162.25 mg/dL K 2.63 mmol/L Na 131.90 mmol/L CI 109.70 mmol/L GIU 4.76 mmol/L
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表 3 脑脊液高通量二代测序结果
检出指标 序列数(RPTM)a) 阳性参考范围 定性结果 单核细胞增生李斯特氏菌 3 068 ≥8 细菌阳性 注：a)RPTM，每10 000条测得序列包含的阳性序列条数(read per ten million)。
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