Elton Andrew C, Levin James, Lazio Matthew P
Division of Pharmaceutical Sciences, University of Wisconsin-Madison School of Pharmacy, Madison, WI, USA.
Madison Emergency Physicians, Madison, WI, USA.
Case Rep Infect Dis. 2017;2017:1051975. doi: 10.1155/2017/1051975. Epub 2017 Aug 14.
meningitis is a rare manifestation of meningitis typically presenting in neonates and the elderly. This infection typically associates with foodborne outbreaks in developing nations and AIDS-endemic regions. We report a case of a 19-year-old male presenting with altered mental status after 3-day absence from work at a Wisconsin tourist area. He was febrile, tachycardic, and tachypneic with a GCS of 8. The patient was intubated and a presumptive diagnosis of meningitis was made. Treatment was initiated with ceftriaxone, vancomycin, acyclovir, dexamethasone, and fluid resuscitation. A lumbar puncture showed cloudy CSF with Gram negative rods. He was admitted to the ICU. CSF culture confirmed subsp. I () Enteritidis (A). Based on this finding, a 4th-generation HIV antibody/p24 antigen test was sent. When this returned positive, a CD4 count was obtained and showed 3 cells/mm, confirming AIDS. The patient ultimately received 38 days of ceftriaxone, was placed on elvitegravir, cobicistat, emtricitabine, and tenofovir alafenamide (Genvoya) for HIV/AIDS, and was discharged neurologically intact after a 44-day admission.
脑膜炎是脑膜炎的一种罕见表现形式，通常在新生儿和老年人中出现。这种感染在发展中国家和艾滋病流行地区通常与食源性疾病暴发有关。我们报告一例19岁男性病例，该患者在威斯康星州旅游区工作3天未上班后出现精神状态改变。他发热、心动过速、呼吸急促，格拉斯哥昏迷评分（GCS）为8分。患者接受了气管插管，并初步诊断为脑膜炎。开始使用头孢曲松、万古霉素、阿昔洛韦、地塞米松进行治疗，并进行液体复苏。腰椎穿刺显示脑脊液浑浊，有革兰氏阴性杆菌。他被收入重症监护病房（ICU）。脑脊液培养确诊为肠炎沙门氏菌亚种I（A）。基于这一发现，进行了四代HIV抗体/p24抗原检测。检测结果呈阳性后，检测了CD4细胞计数，结果显示为3个细胞/mm³，确诊为艾滋病。该患者最终接受了38天的头孢曲松治疗，开始使用埃替格韦、考比司他、恩曲他滨和替诺福韦艾拉酚胺（捷扶康）治疗HIV/AIDS，入院44天后神经功能完好出院。
