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病例报告:一名患者侵袭性肝脓肿综合征合并化脓性脑膜炎的诊断——从病原体到病变

Case Report: Diagnosis of Invasive Liver Abscess Syndrome With Purulent Meningitis in a Patient From Pathogen to Lesions.

作者信息

Zeng Sheng, Yan Wei-Qian, Wu Xiao-Mei, Zhang Hai-Nan

机构信息

Department of Geriatrics, The Second Xiangya Hospital, Central South University, Changsha, China.

Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China.

出版信息

Front Med (Lausanne). 2021 Sep 10;8:714916. doi: 10.3389/fmed.2021.714916. eCollection 2021.

Abstract

As a determinant human pathogen, is known to cause rare liver abscess syndrome (KLAS) which was more common in Asia in early-stage and reported increasingly outside Asia now. Patients with KLAS who have septic metastatic ocular or central nervous system (CNS) lesions are associated with high morbidity and mortality. Relatively infrequent adult community-acquired meningitis have been documented and most were with poor prognosis. In this paper, we reported a case of KLAS presenting purulent meningitis as disease onset. While negative results were obtained in the bacterial culture of CSF, blood, or liver pus, metagenomic next-generation sequencing (mNGS) of CSF, and blood samples which were synchronously performed demonstrated as the pathogenic microorganism (13,470 and 5,318 unique reads, respectively). The ultimately cured patient benefited from rapid pathogen diagnosis, early percutaneous drainage of the abscess, and prompt appropriate antibiotic administration. Our case highlights the importance of clinicians using mNGS for early pathogen diagnosis of this disease.

摘要

作为一种决定性的人类病原体,已知其可引起罕见的肝脓肿综合征(KLAS),该综合征在早期亚洲更为常见,现在在亚洲以外地区的报道也越来越多。患有KLAS且伴有脓毒性转移性眼部或中枢神经系统(CNS)病变的患者,其发病率和死亡率都很高。相对罕见的成人社区获得性脑膜炎已有文献记载,且大多数预后不良。在本文中,我们报告了一例以化脓性脑膜炎为疾病首发表现的KLAS病例。虽然脑脊液、血液或肝脓肿的细菌培养结果均为阴性,但同步进行的脑脊液和血液样本的宏基因组下一代测序(mNGS)显示该病原体(分别有13470和5318条独特读数)。最终治愈的患者得益于快速的病原体诊断、早期脓肿经皮引流以及及时给予适当的抗生素治疗。我们的病例强调了临床医生使用mNGS对该疾病进行早期病原体诊断的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3b9c/8460774/de5eb727bcfb/fmed-08-714916-g0001.jpg

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