Department of Infectious Diseases, Catholic University of Rome, Rome, Italy.
Department of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy.
Infection. 2018 Oct;46(5):591-597. doi: 10.1007/s15010-018-1141-5. Epub 2018 Apr 23.
Mycobacterium abscessus, and rapidly growing mycobacteria in general, are rare but increasing causes of central nervous system (CNS) infections. The aim of this study is to highlight the importance of considering these microorganism in the differential diagnosis of CNS infections, obtaining a prompt diagnosis, and improving clinical outcomes.
Case report and literature review.
We report a case of meningeal infection in a patient who underwent decompressive craniectomy after a craniofacial trauma. The diagnosis was made analyzing a sample obtained during a second operation of cranioplasty. A regimen of amikacin, clarithromycin, and imipenem/cilastatin was started. In the following days, the patient experienced a variety of side effects. So, first clarithromycin was replaced with linezolid, then amikacin was stopped and cefoxitin added to the therapy and at the end all the antibiotics were withdrawn. The patient was discharged in good conditions and a clinical interdisciplinary follow-up was started. After 12 months, the patient is still doing well. After a literature analysis, 15 cases of M. abscessus CNS infections were identified. Various modes of acquisition, underlying disease and therapeutic schemes were evident.
Considering the results of the literature analysis and the increasing incidence of M. abscessus, all specialists involved in the management of CNS infection should be aware of the importance of atypical microorganisms in differential diagnosis.
脓肿分枝杆菌和一般快速生长的分枝杆菌是中枢神经系统（CNS）感染的罕见但日益增加的病因。本研究旨在强调在 CNS 感染的鉴别诊断中考虑这些微生物的重要性，以便及时做出诊断并改善临床结果。
病例报告和文献复习。
我们报告了一例发生在颅脑创伤后行去骨瓣减压术后患者脑膜感染的病例。通过对第二次颅骨成形术时获得的样本进行分析，做出了诊断。采用阿米卡星、克拉霉素和亚胺培南/西司他丁治疗方案。在接下来的几天里，患者出现了多种副作用。因此，首先将克拉霉素替换为利奈唑胺，然后停止使用阿米卡星，并在治疗中加入头孢西丁，最后所有抗生素均被停用。患者情况良好出院，并开始进行临床多学科随访。12 个月后，患者仍状况良好。通过文献分析，共确定了 15 例脓肿分枝杆菌 CNS 感染病例。各种感染途径、潜在疾病和治疗方案均有报道。
鉴于文献分析的结果和脓肿分枝杆菌感染的发病率不断增加，参与 CNS 感染管理的所有专家都应认识到在鉴别诊断中考虑非典型微生物的重要性。
