Nakae Yoshiharu, Kuroiwa Yoshiyuki
Department of Neurology, Yokohama Minami Kyosai Hospital.
Rinsho Shinkeigaku. 2009 Sep;49(9):590-3. doi: 10.5692/clinicalneurol.49.590.
An 83-year-old woman developed high fever and headache for four days. She had disturbance of consciousness and was admitted to our hospital. A lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 268/mm3 and culture became positive for Listeria monocytogenes. Six days after admission, the adenosine deaminase (ADA) level in CSF markedly elevated (43.3 IU/L) with pleocytosis, but a negative PCR test for tuberculosis in CSF, sputum, gastric fluid. She recovered by antibiotics for 45 days and ADA level in CSF was normalized. She was diagnosed as listeria meningitis. High levels of ADA in CSF have high sensitivity and high specificity for tuberculous meningitis, but there are some reports that high ADA levels in CSF in other meningitis. The main biological role of ADA is related to proliferation and differentiation of lymphocytes, and specific activity of this enzyme is slightly higher in T-lymphocytes than in B-lymphocytes. Protective immunity to Listeria monocytogenes is exclusively exhibited by T-lymphocytes. We consider that increased ADA levels in listeria meningitis associated with elevation of T-lymphocytes in CSF. This report suggests that listeria meningitis must be included in the differential diagnosis of high levels of ADA in CSF.
一名83岁女性持续发热、头痛4天。她出现意识障碍，随后入住我院。进行了腰椎穿刺，脑脊液（CSF）分析显示白细胞计数为268/mm³，培养结果显示单核细胞增生李斯特菌呈阳性。入院6天后，脑脊液中的腺苷脱氨酶（ADA）水平显著升高（43.3 IU/L），伴有细胞增多，但脑脊液、痰液、胃液的结核PCR检测均为阴性。她接受了45天的抗生素治疗后康复，脑脊液中的ADA水平恢复正常。她被诊断为李斯特菌脑膜炎。脑脊液中ADA水平升高对结核性脑膜炎具有高敏感性和高特异性，但也有一些报道称其他脑膜炎患者脑脊液中ADA水平也会升高。ADA的主要生物学作用与淋巴细胞的增殖和分化有关，该酶在T淋巴细胞中的比活性略高于B淋巴细胞。对单核细胞增生李斯特菌的保护性免疫仅由T淋巴细胞表现出来。我们认为李斯特菌脑膜炎患者脑脊液中ADA水平升高与脑脊液中T淋巴细胞升高有关。本报告提示，李斯特菌脑膜炎必须纳入脑脊液中ADA水平升高的鉴别诊断。
