Sakamoto Mitsuo, Onodera Shoichi, Takahashi Hideyuki, Watanabe Haruo
Division of Infection Control, The Jikei University School of Medicine.
Kansenshogaku Zasshi. 2007 Nov;81(6):731-5. doi: 10.11150/kansenshogakuzasshi1970.81.731.
We report the case of a patient with acute bronchitis caused by Neisseria meningitidis associated with HIV infection. A 36-year-old homosexual Japanese man being treated for HIV infection and reporting fever and a productive cough was found in laboratory findings to have elevated C-reactive protein but no leukocytosis. Chest radiography showed no infiltrates in either lung, but a sputum smear yielded large numbers of Gram-negative cocci, including some phagocytized by white blood cells. One day later N. meningitidis was reported to be the predominant isolate from sputum culture. The patient was diagnosed with acute bronchitis caused by N. meningitidis. The strain isolated from this patient was in serogroup B. The sequence type based on multilocus sequence typing was ST-5583, a subtype of ST-32. This strain is resistant to penicillin G in vitro, so we administered tosufloxacin at 600mg b.i.d., which showed excellent efficacy. Because of frequent sex with many men, homosexual contact was suspected as a possible route of infection. Meningococcal infections apart from meningitis rarely are surveyed epidemiologically in Japan, and the frequency of meningococcal infections in general is not clear. Vigilance is needed to identify trends in meningococcal infection, because N. meningitidis can cause acute bronchitis.
我们报告了一例由脑膜炎奈瑟菌引起的急性支气管炎患者，该患者合并HIV感染。一名36岁接受HIV感染治疗的日本同性恋男子，自述发热并伴有咳痰，实验室检查发现其C反应蛋白升高，但白细胞未增多。胸部X线检查显示双肺均无浸润影，但痰涂片发现大量革兰氏阴性球菌，其中一些被白细胞吞噬。一天后，痰培养报告显示脑膜炎奈瑟菌为主要分离菌株。该患者被诊断为由脑膜炎奈瑟菌引起的急性支气管炎。从该患者分离出的菌株属于B血清群。基于多位点序列分型的序列类型为ST-5583，是ST-32的一个亚型。该菌株在体外对青霉素G耐药，因此我们给予托氟沙星600mg，每日两次，疗效显著。由于该患者与多名男性有频繁性行为，怀疑同性恋接触是可能的感染途径。在日本，除脑膜炎外，脑膜炎球菌感染很少进行流行病学调查，脑膜炎球菌感染的总体频率尚不清楚。由于脑膜炎奈瑟菌可引起急性支气管炎，因此需要提高警惕以识别脑膜炎球菌感染的趋势。
