Virginia Tech Carilion School of Medicine, Roanoke, VA 24014, USA.
Ann Intern Med. 2013 Feb 5;158(3):154-61. doi: 10.7326/0003-4819-158-3-201302050-00568.
Chinese translation
Administration of epidural steroid injections (ESIs) with contaminated methylprednisolone resulted in an outbreak of fungal meningitis in many locations in the United States.
To characterize early clinical findings and initial response to treatment.
Case series with standardized observation studied from 4 October to 31 October 2012.
An 800-bed hospital in Virginia.
172 patients who presented to the hospital with exposure to contaminated ESI.
Standardized approach to screening, case definition, treatment, and data collection.
Clinical findings, cerebrospinal fluid (CSF) values, magnetic resonance imaging (MRI), serum and CSF voriconazole concentrations, and clinician assessment of response to therapy.
Of 172 patients presenting to the hospital who had had ESI, 131 had lumbar puncture because of symptoms or signs consistent with central nervous system disease. Twenty-five (19%) had neutrophilic meningitis. All were started on voriconazole therapy alone. Three patients developed stroke during treatment. Ten patients had arachnoiditis, another had an epidural abscess, and 9 had urine retention. Fifteen continued to receive voriconazole, and 10 were switched to amphotericin B. Cerebrospinal fluid leukocyte counts began to decrease by day 13 of treatment. Findings on MRI included ventriculitis, leptomeningeal enhancement, infarction, hemorrhage, and arachnoiditis. Serum voriconazole levels varied, and CSF concentrations of voriconazole were approximately 50% those of serum. Exserohilum rostratum and Cladosporium species have been cultured.
This is an observational study of an evolving outbreak. Not all exposed patients presented for evaluation. Follow-up is too short to determine final outcomes.
Meningitis after receipt of contaminated ESI has been diagnosed in many exposed patients presenting to 1 hospital. Most patients have improved on receipt of empirical voriconazole therapy. The full natural history and long-term sequelae of this infection are currently unknown.
None.
中文翻译
硬膜外类固醇注射（ESI）中使用受污染的甲基强的松龙导致美国多个地区爆发真菌性脑膜炎。
描述早期临床发现和初始治疗反应。
2012 年 10 月 4 日至 10 月 31 日进行的标准化观察的病例系列研究。
弗吉尼亚州的一家 800 床医院。
172 名因接触受污染的 ESI 而到医院就诊的患者。
筛查、病例定义、治疗和数据收集的标准化方法。
临床发现、脑脊液（CSF）值、磁共振成像（MRI）、血清和 CSF 伏立康唑浓度以及临床医生对治疗反应的评估。
在因疑似中枢神经系统疾病而行腰椎穿刺的 172 名就诊患者中，有 131 名患者接受了腰椎穿刺。25 名（19%）患者患有中性粒细胞性脑膜炎。所有患者均单独开始伏立康唑治疗。3 名患者在治疗期间发生中风。10 名患者患有蛛网膜炎，另一名患者患有硬膜外脓肿，9 名患者患有尿潴留。15 名患者继续接受伏立康唑治疗，10 名患者转为两性霉素 B。治疗第 13 天开始，脑脊液白细胞计数开始下降。MRI 结果包括脑室炎、软脑膜增强、梗死、出血和蛛网膜炎。伏立康唑的血清水平各不相同，脑脊液中的伏立康唑浓度约为血清的 50%。已培养出外瓶霉属和枝孢属。
这是一项对正在发生的暴发进行的观察性研究。并非所有接触过的患者都来接受评估。随访时间太短，无法确定最终结果。
在 1 家医院就诊的许多接触过的患者中诊断出接受污染 ESI 后发生的脑膜炎。大多数患者在接受经验性伏立康唑治疗后病情有所改善。目前尚不清楚这种感染的完整自然史和长期后果。
无。
