Dinleyici Ener Cagri, Yarar Coskun, Dinleyici Meltem, Yakut Ayten
Eskisehir Osmangazi University Faculty of Medicine, Department of Pediatrics, TR 26480, Eskisehir, Turkey.
J Trop Pediatr. 2007 Dec;53(6):431-3. doi: 10.1093/tropej/fmm058. Epub 2007 Jun 27.
Recent findings have focused on the possible role of linezolid as a suitable candidate for the treatment of central nervous system infections. The linezolid treatment for meningitis was sporadically reported in adults but there was no report in children. Here, we present a 6-month-old boy with meningitis and subdural empyema which was unresponsive to more conventional agents but successfully treated with linezolid therapy. A previously healthy 6-month-old boy was referred to our clinic for deteriorating general condition with fever, vomiting and seizures. He had fever and tense-bulging anterior fontanelle. Based on his first cerebrospinal fluid (CSF) results, empirical antibiotic therapy for bacterial meningitis consisting of vancomycin and ceftriaxone was started. However, CSF culture yielded no micro-organisms but blood culture showed coagulase-negative Staphylococci. On the 7th day, he still had high fever and the erythrocyte sedimentation rate (ESR) and serum CRP levels had risen by 105 mm/h and 36.2 mg/dl, respectively. On 10th day, computerized cranial tomography showed bilateral frontoparietal subdural empyema. Purulent material was evacuated by burr hole, and gram stains of the material showed polymorphonuclear leukocytes and no microorganisms. Clinical and CSF findings of our case were, unresponsiveness to vancomycin, ceftriaxone and consecutive meropenem treatment while we still observed subdural empyema during these treatments. For this reason we started linezolid 10 mg/kg twice daily. Clinical signs improved dramatically, with both completely normal neurological findings and normalization of CSF and radiological findings. To the of our best knowledge, linezolid treatment of meningitis in children has not been reported previously. Clinical and CSF findings of our case were improved completely with linezolid treatment. Also, control cranial computerized tomography showed the total recovery of subdural empyema. Here we present the youngest case with meningitis which was successfully treated with linezolid treatment.
近期研究结果聚焦于利奈唑胺作为治疗中枢神经系统感染合适候选药物的潜在作用。利奈唑胺治疗成人脑膜炎的报道较为零散，而儿童患者尚无相关报道。在此，我们报告一例6个月大患脑膜炎和硬膜下积脓的男童，其对更常规的药物治疗无反应，但利奈唑胺治疗取得成功。一名此前健康的6个月大男童因发热、呕吐和惊厥导致一般状况恶化被转诊至我们诊所。他有发热且前囟饱满紧张。根据其首次脑脊液（CSF）检查结果，开始经验性使用万古霉素和头孢曲松进行细菌性脑膜炎的抗生素治疗。然而，脑脊液培养未发现微生物，但血培养显示凝固酶阴性葡萄球菌。第7天，他仍持续高热，红细胞沉降率（ESR）和血清CRP水平分别升至105mm/h和36.2mg/dl。第10天，头颅计算机断层扫描显示双侧额顶叶硬膜下积脓。通过钻孔引流排出脓性物质，该物质的革兰氏染色显示有多形核白细胞但无微生物。我们病例的临床和脑脊液检查结果显示，对万古霉素、头孢曲松及后续美罗培南治疗均无反应，且在这些治疗期间仍观察到硬膜下积脓。因此，我们开始每日两次给予利奈唑胺10mg/kg。临床症状显著改善，神经学检查结果完全正常，脑脊液及影像学检查结果也恢复正常。据我们所知，此前尚未有儿童脑膜炎使用利奈唑胺治疗的报道。我们病例的临床和脑脊液检查结果经利奈唑胺治疗后完全改善。此外，对照头颅计算机断层扫描显示硬膜下积脓完全恢复。在此我们报告了首例成功使用利奈唑胺治疗的最年幼脑膜炎病例。
