Tan Kevin, Wijaya Limin, Chiew Hui-Jin, Sitoh Yih-Yian, Shafi Humaira, Chen Robert C, Goh Chin Kong, Lim C C Tchoyoson
Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore.
Duke-NUS Graduate Medical School, Singapore.
J Magn Reson Imaging. 2017 Feb;45(2):507-514. doi: 10.1002/jmri.25373. Epub 2016 Jul 29.
In 2015, an outbreak of group B streptococcal (GBS) infection caused by Streptococcus agalactiae Serotype III, multilocus sequence type 283, related to consuming infected raw freshwater fish, affected more than 200 patients in Singapore. We describe the clinical, laboratory, and neuroimaging features of a subgroup of adults with central nervous system (CNS) infections caused by GBS.
The database of the Singapore Neurologic Infections Program (SNIP), a national multicenter study for surveillance of infectious neurologic disease, was reviewed to select patients with GBS CNS infection during the outbreak. Cases were diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) findings and identification or isolation of Streptococcus agalactiae in the blood or CSF. Demographic, clinical and neuroradiological information was obtained prospectively and retrospectively abstracted.
Fourteen patients (6 male, 8 female; median age, 58 years) presented with fever, meningism, headache, encephalopathy, focal neurological deficits, and/or seizures. All except two were previously healthy. Diffusion-weighted imaging (DWI) on admission was abnormal in 13 patients, showing tiny hyperintensities in the subarachnoid space (7 patients), ventricles (6 patients) and brain parenchyma (8 patients); 5 patients had cerebellar abnormalities.
Among healthy non-pregnant adults infected with Serotype III, multilocus sequence type 283 GBS meningitis linked to eating infected raw freshwater fish, DWI detected small pus collections and unusual cerebellar involvement. A collaborative national surveillance system that includes MRI can be helpful during unusual food-borne zoonotic infectious disease outbreaks.
4 J. Magn. Reson. Imaging 2017;45:507-514.
2015年，新加坡发生了一起由无乳链球菌血清型III、多位点序列类型283引起的B族链球菌（GBS）感染疫情，与食用受感染的生淡水鱼有关，超过200名患者受到影响。我们描述了一组由GBS引起的中枢神经系统（CNS）感染的成年患者的临床、实验室和神经影像学特征。
回顾了新加坡神经感染项目（SNIP）的数据库，该项目是一项全国性多中心研究，用于监测感染性神经疾病，以选择疫情期间患有GBS中枢神经系统感染的患者。病例根据临床特征、脑脊液（CSF）检查结果以及血液或脑脊液中无乳链球菌的鉴定或分离进行诊断。前瞻性地获取并回顾性提取人口统计学、临床和神经放射学信息。
14名患者（6名男性，8名女性；中位年龄58岁）出现发热、脑膜刺激征、头痛、脑病、局灶性神经功能缺损和/或癫痫发作。除两名患者外，其余患者此前均健康。入院时13名患者的弥散加权成像（DWI）异常，表现为蛛网膜下腔（7名患者）、脑室（6名患者）和脑实质（8名患者）内微小高信号；5名患者有小脑异常。
在感染血清型III、多位点序列类型283 GBS脑膜炎且与食用受感染生淡水鱼有关的健康非妊娠成年人中，DWI检测到小脓肿以及不寻常的小脑受累情况。一个包括MRI的全国性协作监测系统在不寻常的食源性人畜共患传染病疫情期间可能会有所帮助。
4 J.Magn.Reson.Imaging 2017;45:507 - 514。
