Papandreou A, Hedrera-Fernandez A, Kaliakatsos M, Chong W K, Bhate S
Genetics and Genomics Medicine Unit, UCL-Institute of Child Health, London, UK; Department of Neurology, Great Ormond Street Hospital, London, UK.
Department of Neurology, Great Ormond Street Hospital, London, UK; Department of Paediatrics, Hospital Universitario Río Hortega, Valladolid, Spain.
Eur J Paediatr Neurol. 2016 Jan;20(1):196-9. doi: 10.1016/j.ejpn.2015.08.004. Epub 2015 Sep 3.
Paediatric Listeria meningitis is rare, especially in immuno-competent children, but associated with significant mortality and morbidity and frequent complications.
We report an unusual case of Listeria meningitis in a previously healthy 35 month-old girl with selective spinal grey matter involvement and demyelination in neurophysiological studies. Despite adequate antibiotic treatment, the case was initially complicated by ventriculitis, hydrocephalus and tonsillar herniation through the foramen magnum, requiring external ventricular drainage and subsequent ventriculoperitoneal shunt insertion. Paucity of movements, hypotonia, areflexia and bladder dysfunction then became evident.
Electromyogram and nerve conduction studies showed acute inflammatory demyelinating polyneuropathy and the patient received intravenous immunoglobulin followed by corticosteroids. MRI scans with contrast revealed extensive whole cord selective grey matter signal changes. She required extensive neurorehabilitation, making gradual (but incomplete) recovery.
Spinal cord involvement is rare in neuro-listeriosis and there no previous paediatric reports of Listeria-related myelitis or demyelinating polyneuropathy. The mechanism behind these presentations is unclear but an auto-immune response to the infection might be considered.
小儿李斯特菌性脑膜炎较为罕见，在免疫功能正常的儿童中尤为如此，但它与显著的死亡率、发病率及频繁的并发症相关。
我们报告了一例不寻常的李斯特菌性脑膜炎病例，患儿为一名35个月大的既往健康女童，神经生理学研究显示选择性脊髓灰质受累及脱髓鞘。尽管进行了充分的抗生素治疗，但该病例最初并发了脑室炎、脑积水及经枕骨大孔的小脑扁桃体疝，需要进行外部脑室引流及随后的脑室腹腔分流术置入。随后出现了运动减少、肌张力减退、反射消失及膀胱功能障碍。
肌电图和神经传导研究显示为急性炎症性脱髓鞘性多发性神经病，患者接受了静脉注射免疫球蛋白治疗，随后使用了皮质类固醇。增强MRI扫描显示脊髓广泛的选择性灰质信号改变。她需要广泛的神经康复治疗，并逐渐（但不完全）康复。
脊髓受累在神经型李斯特菌病中罕见，之前尚无小儿李斯特菌相关脊髓炎或脱髓鞘性多发性神经病的报道。这些表现背后的机制尚不清楚，但可能考虑为对感染的自身免疫反应。
