Dept of Women, Child, General and Specialist Surgery, University of Campania "L. Vanvitelli", Naples, Italy.
J Med Case Rep. 2021 Mar 29;15(1):138. doi: 10.1186/s13256-021-02731-7.
Gram-negative bacteria are an uncommon etiology of spontaneous community-acquired adult meningitis and meningoencephalitis. Escherichia coli is a Gram-negative bacterium that is normally present in the intestinal microbial pool. Some Escherichia coli strains can cause diseases in humans and animals, with both intestinal and extraintestinal manifestations (extraintestinal pathogenic Escherichia coli) such as urinary tract infections, bacteremia with sepsis, and, more rarely, meningitis. Meningitis continues to be an important cause of mortality throughout the world, despite progress in antimicrobial chemotherapy and supportive therapy. The mortality rate fluctuates between 15% and 40%, and about 50% of the survivors report neurological sequelae. The majority of Escherichia coli meningitis cases develop as a result of hematogenous spread, with higher degrees of bacteremia also being related to worse prognosis. Cases presenting with impaired consciousness (that is, coma) are also reported to have poorer outcomes.
We describe the case of a 48-year-old caucasian woman with meningoencephalitis, with a marked alteration of consciousness on admission, and septic shock secondary to pyelonephritis caused by Escherichia coli, treated with targeted antimicrobial therapy and immunoglobulin-M-enriched immunoglobulin (Pentaglobin) preparation as adjuvant therapy.
Despite the dramatic presentation of the patient on admission, the conflicting data on the use of immunoglobulins in septic shock, and the lack of evidence regarding their use in adult Escherichia coli meningoencephalitis, we obtained a remarkable improvement of her clinical condition, accompanied by partial resolution of her neurological deficits.
革兰氏阴性菌是一种不常见的自发性社区获得性成人脑膜炎和脑膜脑炎的病因。大肠杆菌是一种革兰氏阴性菌，通常存在于肠道微生物群中。一些大肠杆菌菌株可引起人类和动物的疾病，具有肠道和肠道外表现（肠外致病性大肠杆菌），如尿路感染、败血症伴菌血症，以及更罕见的脑膜炎。尽管在抗菌化疗和支持治疗方面取得了进展，但脑膜炎仍然是全世界重要的死亡原因。死亡率在 15%至 40%之间波动，约 50%的幸存者报告有神经后遗症。大多数大肠杆菌脑膜炎病例是由于血行播散引起的，较高程度的菌血症也与预后较差有关。有报道称，意识障碍（即昏迷）的病例预后较差。
我们描述了一例 48 岁白人女性，患有脑膜脑炎，入院时意识明显改变，并发由大肠杆菌引起的肾盂肾炎性败血症性休克，采用靶向抗菌治疗和免疫球蛋白 M 富集免疫球蛋白（Pentaglobin）制剂作为辅助治疗。
尽管患者入院时病情严重，关于免疫球蛋白在败血症性休克中的应用存在矛盾的数据，以及关于其在成人大肠杆菌性脑膜脑炎中的应用缺乏证据，但我们的治疗使患者的临床状况显著改善，同时她的神经功能缺损也部分得到了恢复。
