Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Victoria, Australia.
Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Int J Infect Dis. 2018 Jun;71:30-32. doi: 10.1016/j.ijid.2018.04.005. Epub 2018 Apr 12.
A case of Streptococcus gallolyticus subsp. pasteurianus meningitis, unusually occurring in a splenectomized patient and complicated by cerebral venous thrombosis, is described. Following presentation with meningism and diagnosis and management of S. gallolyticus meningitis, the patient presented again with a further 4days of fevers and subsequently developed left-sided paresthesias. Cerebral imaging revealed a venous thrombus in the right frontal cortical veins and left sigmoid sinus. The patient recovered following 4 weeks of intravenous ceftriaxone and anticoagulation with enoxaparin and then warfarin. Apart from the splenectomy, no underlying cause was found. The patient was commenced on life-long prophylactic amoxicillin, given appropriate vaccinations, and anticoagulated with warfarin. After initial difficulties, identification of the causative organism to the subspecies level was confirmed by analysis of short-read whole genome sequencing data. This case demonstrates two features that have not previously been reported for S. gallolyticus subsp. pasteurianus infections: splenectomy as a potential risk factor and that infection may be complicated by cerebral venous thrombosis. The resolution provided by whole genome sequencing was valuable in accurately identifying the bacterial subspecies.
本文描述了一例罕见的发生于脾切除术后患者的伴发脑静脉血栓形成的天噬肠球菌巴氏亚种脑膜炎。该患者最初表现为脑膜炎症状，诊断并治疗了天噬肠球菌脑膜炎，4 天后再次出现发热，并随后出现左侧感觉异常。脑部影像学显示右侧额皮质静脉和左侧乙状窦内有静脉血栓。该患者接受了 4 周的头孢曲松静脉注射和依诺肝素及华法林抗凝治疗后康复。除了脾切除术，没有发现其他潜在病因。该患者开始接受终身预防性阿莫西林治疗，接种了适当的疫苗，并接受华法林抗凝治疗。在最初遇到困难后，通过短读长全基因组测序数据分析确认了该致病生物体亚种级别的鉴定。该病例有两个以前未报道过的天噬肠球菌巴氏亚种感染特征：脾切除术是一个潜在的危险因素，感染可能并发脑静脉血栓形成。全基因组测序提供的分辨率有助于准确鉴定细菌亚种。
