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一例罕见的由多杀巴斯德菌引起的新生儿败血症/脑膜炎,并发癫痫持续状态和局灶性脑炎。

A rare case of neonatal sepsis/meningitis caused by Pasteurella multocida complicated with status epilepticus and focal cerebritis.

作者信息

Spadafora R, Pomero G, Delogu A, Gozzoli L, Gancia P

机构信息

Terapia Intensiva Neonatale-Neonatologia, ASO S. Croce e Carle, Cuneo, Italy.

出版信息

Pediatr Med Chir. 2011 Jul-Aug;33(4):199-202.

Abstract

Pasteurella multocida is normally present in respiratory and digestive tract of many domestic and wild animals, but is a rare pathogen in neonatal infection. Here we describe for the first time a case of meningitis complicated by status epilepticus and right parietal lobe cerebritis. The patient showed a dramatic clinical onset characterized by septic appearance and prolonged seizures. Multidrug anticonvulsivant therapy was used to control the status epilepticus, but despite the aggressive treatment electrical crises were still evident 24 hours after the admission. Furthermore, a brain MRI, performed to investigate a persistent intermittent fever even if CSF became sterile, showed a focus cerebritis in the right parietal lobe, early stage of the cerebral abscess. Prolonged antibiotic therapy with steroids was requested to solve the cerebritis area. Interestingly, direct contact between the patient and domestic animals was denied by the family, but the father reported a contact with a rooster, killed and cooked few days before, suggesting, as previously described, that Pasteurella may also be transmitted through asymptomatic human carrier. The patient had a favourable outcome with no medium-term sequelae one month after discharge, but the severity of the clinical course and the unpredictable way of transmission highlight the importance of hygiene measures approaching infants.

摘要

多杀巴斯德菌通常存在于许多家畜和野生动物的呼吸道和消化道中,但在新生儿感染中是一种罕见的病原体。在此,我们首次描述了一例并发癫痫持续状态和右顶叶脑炎的脑膜炎病例。该患者临床起病急剧,表现为败血症外观和长时间癫痫发作。使用多种抗惊厥药物治疗来控制癫痫持续状态,但尽管积极治疗,入院24小时后仍有明显的电发作危机。此外,为了调查即使脑脊液无菌但仍持续间歇性发热的情况而进行的脑部MRI显示右顶叶有一个脑炎病灶,处于脑脓肿的早期阶段。需要长期使用抗生素和类固醇治疗来解决脑炎区域问题。有趣的是,患者家属否认患者与家畜有直接接触,但父亲报告在几天前接触过一只被宰杀并烹饪的公鸡,如先前所述,这表明巴斯德菌也可能通过无症状的人类携带者传播。患者出院后一个月预后良好,无中期后遗症,但临床病程的严重性和不可预测的传播方式凸显了接近婴儿时卫生措施的重要性。

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