Ohnishi Takuma, Kawano Akiko, Araki Mayumi, Hamahata Yuko, Usui Machiko, Shimoyamada Motoko, Tamame Takuya, Akashi Masayuki, Sato Seiji
Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan.
Department of Pediatrics, Saitama City Hospital, Saitama, Japan.
Keio J Med. 2017 Jun 25;66(2):25-28. doi: 10.2302/kjm.2016-0007-CR. Epub 2017 Apr 7.
Listeria monocytogenes only occasionally causes bacterial meningitis in immunocompetent children. We report a case of L. monocytogenes meningitis associated with rotavirus gastroenteritis. The patient was a previously healthy 20-month-old girl who was admitted because of sustained fever and lethargy after suffering from gastroenteritis for 6 days. The patient's peripheral white blood cell count was 18,600/µL and the C-reactive protein level was 2.44 mg/dL. A stool sample tested positive for rotavirus antigen. A cerebrospinal fluid (CSF) sample showed pleocytosis. Cultures of the CSF and stool samples revealed the presence of L. monocytogenes. The patient was successfully treated with ampicillin and gentamicin. We speculate that translocation of enteric flora across the intestinal epithelium that had been damaged by rotavirus gastroenteritis might have caused bacteremia that disseminated into the CSF. Both listeriosis and secondary systemic infection after rotavirus gastroenteritis are rare but not unknown. Initiation of appropriate treatment as soon as possible is important for all types of bacterial meningitis. This rare but serious complication should be taken into consideration even if the patient does not have any medical history of immune-related problems.
单核细胞增生李斯特菌仅偶尔在免疫功能正常的儿童中引起细菌性脑膜炎。我们报告一例与轮状病毒胃肠炎相关的单核细胞增生李斯特菌脑膜炎病例。该患者是一名此前健康的20个月大女童,因患胃肠炎6天后持续发热和嗜睡入院。患者外周血白细胞计数为18,600/µL,C反应蛋白水平为2.44 mg/dL。粪便样本轮状病毒抗原检测呈阳性。脑脊液(CSF)样本显示细胞增多。脑脊液和粪便样本培养均发现存在单核细胞增生李斯特菌。患者接受氨苄西林和庆大霉素治疗成功。我们推测,被轮状病毒胃肠炎损伤的肠道上皮细胞处肠道菌群的易位可能导致了菌血症,进而扩散至脑脊液。李斯特菌病和轮状病毒胃肠炎后的继发性全身感染均罕见但并非不为人知。对于所有类型的细菌性脑膜炎,尽早开始适当治疗很重要。即使患者没有任何免疫相关问题的病史,也应考虑到这种罕见但严重的并发症。