Greve Thomas, Clemmensen Dorte, Ridderberg Winnie, Pedersen Lisbeth N, Møller Jens K
Department of Clinical Microbiology, Aarhus University Hospital, Skejby, Denmark.
BMJ Case Rep. 2011 Mar 1;2011:bcr0920103344. doi: 10.1136/bcr.09.2010.3344.
The authors report a case of a subdural empyema (SDE) caused by a coinfection with Streptococcus intermedius and Streptococcus pneumoniae, initially considered a S. intermedius infection only. An otherwise healthy 11-year-old female was admitted to the hospital after 5 days of illness. Symptoms were consistent with classical SDE symptoms and progressed rapidly with finally somnolence before the first neurosurgical procedure despite relevant antibiotic treatment. Primary MRI showed an interhemispheric SDE and a postoperative control CT scan showed progression of the empyema infratentorially. The empyema was evacuated twice, day 8 and 18, with good results. Primary samples showed growth of S. intermedius only. The severity of the clinical picture elicited supplementary samples, which were additionally positive for S. pneumoniae by an in-house specific lytA PCR and/or a commercial antigen test.
作者报告了一例由中间型链球菌和肺炎链球菌合并感染引起的硬脑膜下积脓（SDE）病例，最初仅被认为是中间型链球菌感染。一名原本健康的11岁女性在患病5天后入院。症状与典型的SDE症状相符，尽管进行了相关抗生素治疗，但病情仍迅速进展，在首次神经外科手术前最终出现嗜睡症状。初次MRI显示大脑半球间SDE，术后对照CT扫描显示幕下积脓进展。分别在第8天和第18天进行了两次积脓引流，效果良好。初次样本仅显示中间型链球菌生长。临床症状的严重性促使进行了补充样本检测，通过内部特异性lytA PCR和/或商业抗原检测，这些补充样本对肺炎链球菌呈阳性。
