Pendlebury W W, Perl D P, Munoz D G
Department of Pathology, University of Vermont, Burlington 05405.
J Neuropathol Exp Neurol. 1989 May;48(3):290-300. doi: 10.1097/00005072-198905000-00006.
We reviewed 2,107 consecutive autopsies with neuropathologic examination at the Medical Center Hospital of Vermont, and identified 92 cases with significant pathologic evidence for infection involving the central nervous system (CNS). Of these, 35 took the form of multiple microabscesses. There were 19 men and 16 women, mean age 56. All patients were chronically ill, usually with an associated impaired immunity. The lung was the most frequent site of primary infection, and sepsis was often present. The most commonly identified causative organisms were Staphylococcus aureus and Candida albicans. Patients with CNS microabscesses developed a progressive encephalopathy associated with waxing and waning signs and symptoms. Laboratory and neuroradiologic studies were not helpful in elucidating the problem. We conclude that multiple microabscesses are a frequent, usually unrecognized, manifestation of CNS infection, and should be considered in the differential diagnosis of encephalopathy in hospitalized patients with chronic disease, immunosuppression and sepsis.
我们回顾了佛蒙特大学医学中心医院连续进行的2107例尸检及神经病理学检查，确定了92例有中枢神经系统（CNS）感染显著病理证据的病例。其中，35例表现为多发性微脓肿。患者有19名男性和16名女性，平均年龄56岁。所有患者均患有慢性病，通常伴有免疫功能受损。肺部是最常见的原发性感染部位，常伴有败血症。最常见的致病微生物是金黄色葡萄球菌和白色念珠菌。患有CNS微脓肿的患者会出现与症状波动相关的进行性脑病。实验室和神经放射学研究无助于阐明该问题。我们得出结论，多发性微脓肿是CNS感染的常见表现，通常未被认识，在患有慢性病、免疫抑制和败血症的住院患者脑病的鉴别诊断中应予以考虑。
