A case report of Vibrio furnissi encephalitis in diabetic patients after eating dead fish
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摘要: 糖尿病患者感染后并发脓毒症多见，但出现弗氏弧菌脑炎既往没有报道，临床诊断罕见。本病例是血糖控制不佳的糖尿病患者食用烹饪的死鱼后出现恶心、呕吐及腹痛的消化道症状，治疗过程中发现肾结石予以碎石后继发泌尿系脓毒症，随后出现了意识障碍，行脑脊液宏基因二代测序(metagenomic next-generation sequencing，mNGS)考虑弗氏弧菌脑炎，给予多西环素治疗后临床症状好转并出院。弗氏弧菌脑炎罕见，糖尿病患者因不洁饮食，特别是食用不洁的水产品后出现意识障碍，结合患者临床表现、脑脊液mNGS结果可明确诊断，敏感的抗生素是控制病情的关键。Abstract: Sepsis is a common occurrence in diabetic patients after infection, but Vibrio frei encephalitis has not been reported in the past, and its clinical diagnosis is rare.However, in this case, a diabetic patient with poor blood glucose control developed gastrointestinal symptoms of nausea, vomiting, and abdominal pain after eating cooked dead fish. During the treatment, kidney stones were found and were removed through lithotomy, however urinary tract sepsis was presented, followed by disturbance of consciousness. Cerebrospinal fluid mNGS was considered for Vibrio frei encephalitis. After doxycycline treatment, the patient was discharged. Vibrio frei encephalitis is rare. However, for diabetic patients with an unclean diet, especially after eating contaminated aquatic products, this case was diagnosed by cerebrospinal fluid mNGS and the sensitive antibiotics are the key to control the disease.
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Key words:
- diabetes mellitus /
- vibrio furnissi /
- sepsis /
- metagenomic next-generation sequencing
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表 1 脑脊液常规检查结果
检查指标 入院第1日 入院第4日 颜色 无色 淡黄色 透明度 透明 透明 凝固性 无凝块 无凝块 蛋白定性 阴性 阴性 细胞总数/(×106/L) 4 476 有核细胞计数/(×106/L) 3 3 
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表 2 脑脊液生化检查结果
检查指标 入院第1日 入院第4日 乳酸脱氢酶/(IU/L) 22 42 蛋白/(g/L) 0.70 0.47 糖/(mmol/L) 8.04 7.76 氯/(mmol/L) 133.2 130.4
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表 3 脑脊液宏基因二代测序结果
检查指标 入院第1日 入院第4日 弗氏弧菌(序列数)a) 2 165 36 a)序列数：每10 000条测得序列包含的阳性序列条数(read per tenminllion)。
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