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[双侧硬膜下积脓并发胎儿弯曲菌胎儿亚种脑膜炎病例]

[Case of bilateral subdural empyema complicating Campylobacter fetus subspecies fetus meningitis].

作者信息

Kanayama Seisaku, Ohnishi Kenji, Yamaura Tadayoshi, Katayama Mituya, Makino Jun, Takemura Nobuhiko, Hamabe Yuichi

机构信息

Department of Neurosurgery, Tokyo Metropolitan Bokutoh Hospital, Japan.

出版信息

Brain Nerve. 2008 Jun;60(6):659-62.

Abstract

Campylobacter fetus subspecies fetus (C. fetus) is a relatively rare cause of meningitis, with only 3 cases of C. fetus subdural empyema reported to date. We experienced a case of bilateral subdural empyema complicating C. fetus meningitis. A 51-year-old man was found lying unconscious on a street and was brought to the hospital in an ambulance. He had no past history of any underlying disease but he had suffered head trauma approximately 1 month prior to this episode. On admission, he had high fever and developed a convulsion fit. Because the cerebrospinal fluid (CSF) findings showed mononuclear dominant pleocytosis and Gram staining revealed spiral-shaped gram negative bacilli, meningitis caused by C. fetus was suspected. Brain CT preformed on admission did not reveal any obvious abnormality. He was immediately treated with antibiotics effective against C. fetus. His disease was complicated by bilateral subdural empyema; therefore, bilateral burr hole drainage was performed. Durling the operation, a hematoma with an outer membrane and containing yellowish pus was revealed. Infection of a chronic subdural hematoma and consequent formation of subdural empyema was deduced. Eventually, C. fetus was isolated from the CSF arterial blood and subdural empyema. The patient was discharged with no complication after the completion of the treatment.

摘要

胎儿弯曲杆菌胎儿亚种(胎儿弯曲杆菌)是脑膜炎相对罕见的病因,迄今为止仅报告了3例胎儿弯曲杆菌硬膜下积脓病例。我们遇到了一例并发胎儿弯曲杆菌脑膜炎的双侧硬膜下积脓病例。一名51岁男性被发现昏迷倒在街头,被救护车送往医院。他既往无任何基础疾病史,但在此事件发生前约1个月曾遭受头部外伤。入院时,他高热并出现惊厥发作。由于脑脊液(CSF)检查结果显示以单核细胞为主的细胞增多,革兰氏染色显示螺旋形革兰氏阴性杆菌,怀疑是由胎儿弯曲杆菌引起的脑膜炎。入院时进行的脑部CT未显示任何明显异常。他立即接受了对胎儿弯曲杆菌有效的抗生素治疗。他的病情并发双侧硬膜下积脓;因此,进行了双侧钻孔引流。手术过程中,发现一个有外膜且含有淡黄色脓液的血肿。推测为慢性硬膜下血肿感染并继而形成硬膜下积脓。最终,从脑脊液、动脉血和硬膜下积脓中分离出胎儿弯曲杆菌。治疗结束后,患者无并发症出院。

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