Oyanguren B, Esteban L, Guillán M, de Felipe A, Alonso Cánovas A, Navas E, Quereda C, Corral I
Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España.
Neurologia. 2015 Apr;30(3):158-62. doi: 10.1016/j.nrl.2013.12.002. Epub 2014 Sep 10.
Streptococcus agalactiae is frequently an asymptomatic coloniser and a cause of neonatal and puerperal sepsis. Infections in nonpregnant adults are uncommon. The frequency of neurological complications caused by invasive infection with this microorganism in adults remains unknown. Here, we study the frequency and characteristics of central nervous system (CNS) involvement in adults with invasive S. agalactiae infection.
Review of all adults with invasive S. agalactiae infection between 2003 and 2011 in a tertiary hospital.
S. agalactiae was isolated from blood, CSF or synovial fluid in 75 patients. Among them, 7 (9,3%) displayed neurological involvement: 5 men and 2 nonpregnant women, aged between 20 and 62 years. Diagnoses were spinal epidural abscess due to spondylodiscitis with spinal cord compression; acute bacterial meningitis; ischemic stroke as presentation of bacterial endocarditis (2 patients each); and meningoventriculitis after neurosurgery and ventricular shunting. One patient with endocarditis caused by S. agalactiae and S. aureus died in the acute phase, and another died 3 months later from metastatic cancer. The other patients recovered without sequelae. All patients had systemic predisposing factors for infection and 5 (71,4%) had experienced disruption of the mucocutaneous barrier as a possible origin of the infection.
CNS involvement is not uncommon in adult patients with invasive infection caused by S. agalactiae. Isolating S. agalactiae, especially in cases of meningitis, should lead doctors to search for predisposing systemic disease and causes of mucocutaneous barrier disruption.
无乳链球菌通常是无症状定植菌，也是新生儿和产褥期败血症的病因。非妊娠成年期感染并不常见。这种微生物侵袭性感染在成人中引起神经并发症的频率尚不清楚。在此，我们研究成人侵袭性无乳链球菌感染中枢神经系统（CNS）受累的频率和特征。
回顾一家三级医院2003年至2011年间所有侵袭性无乳链球菌感染的成人患者。
75例患者的血液、脑脊液或滑液中分离出无乳链球菌。其中7例（9.3%）出现神经受累：5例男性和2例非妊娠女性，年龄在20至62岁之间。诊断包括因脊椎间盘炎伴脊髓受压导致的脊髓硬膜外脓肿；急性细菌性脑膜炎；作为细菌性心内膜炎表现的缺血性中风（各2例）；神经外科手术和脑室分流术后的脑膜脑室炎。1例由无乳链球菌和金黄色葡萄球菌引起的心内膜炎患者在急性期死亡，另1例3个月后死于转移性癌症。其他患者康复且无后遗症。所有患者均有全身性感染易感因素，5例（71.4%）有黏膜皮肤屏障破坏作为可能的感染源。
成人侵袭性无乳链球菌感染患者中枢神经系统受累并不少见。分离出无乳链球菌，尤其是在脑膜炎病例中，应促使医生寻找全身性易感疾病和黏膜皮肤屏障破坏的原因。
