Chang Wen-Neng, Tsai Yu-Chun, Chien Chun-Chih, Huang Chi-Ren, Lu Cheng-Hsien
Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung, 123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Hsien, Taiwan, ROC.
Clin Neurol Neurosurg. 2002 May;104(2):121-4. doi: 10.1016/s0303-8467(01)00193-7.
Adult Proteus (P.) mirabilis meningitis is relatively rare and has not been examined individually in the English-language literature. During a period of 15 years (January 1986-December 2000), four adult patients with P. mirabilis meningitis and one adult patient with mixed bacterial meningitis involving P. mirabilis were identified at Chang Gung Memorial Hospital, Kaohsiung. These five patients included one man and four women, aged from 19 to 74 years (mean age=55.4). P. mirabilis infection accounted for 1.7% (4/229) of cases of our culture-proven monomicrobial adult bacterial meningitis and was involved in 7.1% (1/14) of cases of our adult mixed bacterial meningitis during this period. Underlying debilitating conditions including diabetes mellitus and neurosurgical disorders were common in these five cases. Adult P. mirabilis meningitis had an acute clinical course, with fever and consciousness-disturbance occurring as most prominent clinical manifestations in all patients. Other common manifestations included hydrocephalus, seizure, septic shock and wound infection. Hematogenous spread would appear to be the most likely mechanism. Multi-antibiotic resistant strains of P. mirabilis were not found in our patients. All strains were susceptible to third-generation cephalosporins, imipenem, aztreonam and ciprofloxacin. The results of treatment for adult P. mirabilis meningitis were not satisfactory, most of the patients surviving with severe neurological deficit.
成人奇异变形杆菌脑膜炎相对罕见，英文文献中尚未对其进行单独研究。在15年期间（1986年1月至2000年12月），高雄长庚纪念医院共确诊4例成人奇异变形杆菌脑膜炎患者和1例合并奇异变形杆菌的成人混合细菌性脑膜炎患者。这5例患者包括1名男性和4名女性，年龄在19至74岁之间（平均年龄=55.4岁）。在此期间，奇异变形杆菌感染占我院经培养证实的成人单微生物细菌性脑膜炎病例的1.7%（4/229），占成人混合细菌性脑膜炎病例的7.1%（1/14）。这5例患者中常见的基础衰弱性疾病包括糖尿病和神经外科疾病。成人奇异变形杆菌脑膜炎临床病程呈急性，所有患者最突出的临床表现为发热和意识障碍。其他常见表现包括脑积水、癫痫、感染性休克和伤口感染。血行播散似乎是最可能的感染途径。在我们的患者中未发现多重耐药的奇异变形杆菌菌株。所有菌株对第三代头孢菌素、亚胺培南、氨曲南和环丙沙星敏感。成人奇异变形杆菌脑膜炎的治疗效果并不理想，大多数患者存活但伴有严重神经功能缺损。
