Department of Neurology, Academic Medical Centre, Centre of Infection and Immunity Amsterdam (CINIMA), The Netherlands.
Department of Medical Microbiology, Academic Medical Centre, Centre of Infection and Immunity Amsterdam (CINIMA), The Netherlands.
Clin Microbiol Infect. 2015 Dec;21(12):1077-83. doi: 10.1016/j.cmi.2015.08.003. Epub 2015 Aug 24.
We describe the incidence and patient characteristics of Streptococcus gallolyticus meningitis. We identified S. gallolyticus meningitis in a nationwide cohort of patients with community-acquired bacterial meningitis, and performed a systematic review and meta-analysis of all reported adult cases in the literature. Five cases were identified (0.3%) in a cohort of 1561 episodes of bacterial meningitis. In one patient, bowel disease (colon polyps) was identified as a predisposing condition for S. gallolyticus infection, whereas no patients were diagnosed with endocarditis. In a combined analysis of our patients and 37 reported in the literature, we found that the median age was 59 years. Predisposing factors were present in 21 of 42 patients (50%), and mainly consisted of immunosuppressive therapy (seven patients), cancer (four patients), and alcoholism (four patients). Colon disease was identified in 15 of 24 patients (63%) and endocarditis in five of 27 patients (18%). Co-infection with Strongyloides stercoralis was identified in 14 of 34 patients (41%), ten of whom were infected with human immunodeficiency virus or human T-lymphotropic virus. Outcomes were described for 37 patients; eight died (22%) and one (3%) had neurological sequelae. S. gallolyticus is an uncommon cause of bacterial meningitis, with specific predisposing conditions. When it is identified, consultation with a cardiologist and gastroenterologist is warranted to rule out underlying endocarditis or colon disease. Stool examinations for Strongyloides stercoralis should be performed in patients who have travelled to or originate from endemic areas.
我们描述了酿脓链球菌性脑膜炎的发病率和患者特征。我们在一项全国性的社区获得性细菌性脑膜炎患者队列中发现了酿脓链球菌性脑膜炎，并对文献中所有报告的成人病例进行了系统回顾和荟萃分析。在 1561 例细菌性脑膜炎患者中，发现了 5 例（0.3%）。在其中一名患者中，肠道疾病（结肠息肉）被确定为酿脓链球菌感染的易患因素，而没有患者被诊断为心内膜炎。在对我们的患者和文献中报告的 37 例患者的综合分析中，我们发现中位年龄为 59 岁。42 例患者中有 21 例（50%）存在易患因素，主要包括免疫抑制治疗（7 例）、癌症（4 例）和酗酒（4 例）。15 例（63%）患者有结肠疾病，5 例（18%）患者有心内膜炎。34 例患者中有 14 例（41%）合并感染旋毛虫，其中 10 例感染人类免疫缺陷病毒或人类 T 淋巴细胞病毒。对 37 例患者的结局进行了描述；8 例死亡（22%），1 例（3%）有神经后遗症。酿脓链球菌是细菌性脑膜炎的一种罕见病因，具有特定的易患因素。当发现酿脓链球菌时，应咨询心脏病专家和胃肠病专家，以排除潜在的心内膜炎或结肠疾病。对于曾前往或来自流行地区的患者，应进行粪便旋毛虫检查。
