Hatipoğlu Ciğdem Ataman, Yildiz Eda, Köktekir Ender, Ipekkan Korhan, Karakoç Esra Alp, Demiröz Ali Pekcan
SB Ankara Eğitim ve Araştirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Kliniği, Ankara.
Mikrobiyol Bul. 2008 Oct;42(4):695-9.
Although Leuconostoc species are rarely pathogenic for humans, they may sometimes give rise to serious infections. In this report, a case of meningitis caused by vancomycin resistant Leuconostoc spp. was reported. Fifty-seven years old female patient was admitted to the hospital with the complaints of headache and sudden onset of unconsciousness and hospitalized in the neurosurgery department because of subarachnoidal hemorrhage. Patient was followed up with dexamethasone treatment and daily lumbar puncture without any surgical intervention. The findings of hemorrhage were receded in the cerebrospinal fluid (CSF) and the consciousness of the patient improved gradually. However, on the ninth day of the hospitalization, the patient became febrile and confused; white blood cell count was 7920/mm3, protein level was 1952 mg/l in the CSF examination. Nosocomial meningitis was diagnosed and empirical treatment with ceftazidime (3 x 2 g/day) and vancomycin (4 x 500 mg/day) was started. CSF culture revealed growth of gram-positive cocci which were identified as Leuconostoc spp. by VITEK 2 Compact (Biomerieux, France) and Phoenix Instrument (Becton-Dickinson, USA) systems. Since the isolate was found susceptible to penicillin, ampicillin, cefotaxime, cefepime, chloramphenicol, clindamycin, erythromycin and linezolid, and resistant to vancomycin by disk diffusion and miniAPI ATB STREP 5 (Biomerieux, France) methods, the treatment was switched to linezolid (2 x 600 mg/day). Vancomycin and teicoplanin resistance was confirmed by E-test. The treatment was continued with linezolid and the patient's clinical condition improved after 14 days of treatment. The possible way of Leuconostoc transmission in this case was thought to be the lumbar punctures performed during the follow-up of subarachnoid hemorrhage. This presentation which demonstrated that Leuconostoc spp. might rarely lead to meningitis, also pointed out that when a vancomycin resistant gram-positive coccus was identified, Leuconostoc spp. should always be kept in mind.
虽然明串珠菌属对人类致病性罕见，但有时可能引发严重感染。本报告报道了1例由耐万古霉素明串珠菌引起的脑膜炎病例。一名57岁女性患者因头痛和突发意识丧失入院，因蛛网膜下腔出血入住神经外科。患者接受地塞米松治疗和每日腰椎穿刺，未进行任何手术干预。脑脊液（CSF）中出血情况消退，患者意识逐渐改善。然而，住院第9天，患者发热且意识模糊；脑脊液检查白细胞计数为7920/mm³，蛋白水平为1952mg/l。诊断为医院获得性脑膜炎，开始经验性使用头孢他啶（3×2g/天）和万古霉素（4×500mg/天）治疗。脑脊液培养显示革兰氏阳性球菌生长，通过VITEK 2 Compact（法国生物梅里埃公司）和Phoenix仪器（美国BD公司）系统鉴定为明串珠菌属。由于通过纸片扩散法和miniAPI ATB STREP 5（法国生物梅里埃公司）方法发现该分离株对青霉素、氨苄西林、头孢噻肟、头孢吡肟、氯霉素、克林霉素、红霉素和利奈唑胺敏感，对万古霉素耐药，治疗改为利奈唑胺（2×600mg/天）。通过E试验确认了万古霉素和替考拉宁耐药。继续使用利奈唑胺治疗，治疗14天后患者临床状况改善。该病例中明串珠菌传播的可能途径被认为是蛛网膜下腔出血随访期间进行的腰椎穿刺。本病例表明明串珠菌属可能很少导致脑膜炎，同时也指出当鉴定出耐万古霉素革兰氏阳性球菌时，应始终考虑到明串珠菌属。
