Department of Neurology, First People's Hospital of Changde City, Changde, Hunan, China.
BMC Infect Dis. 2021 Oct 26;21(1):1105. doi: 10.1186/s12879-021-06797-y.
Enterococcus faecalis (E. faecalis) meningitis is a rare disease, and most of its occurrences are of post-operative origin. Its rapid diagnosis is critical for effective clinical management. Currently, the diagnosis is focused on cerebrospinal fluid (CSF) culture, but this is quite limited. By comparison, metagenomic next-generation sequencing (mNGS) can overcome the deficiencies of conventional diagnostic approaches. To our knowledge, mNGS analysis of the CSF in the diagnosis of E. faecalis meningitis has been not reported.
We report the case of E. faecalis meningitis in a 70-year-old female patient without a preceding history of head injury or surgery, but with an occult sphenoid sinus bone defect. Enterococcus faecalis meningitis was diagnosed using mNGS of CSF, and she recovered satisfactorily following treatment with appropriate antibiotics and surgical repair of the skull bone defect.
Non-post-traumatic or post-surgical E. faecalis meningitis can occur in the presence of occult defects in the cranium, and mNGS technology could be helpful in diagnosis in the absence of a positive CSF culture.
粪肠球菌（E. faecalis）脑膜炎是一种罕见疾病，大多数发生于术后。快速诊断对于有效临床管理至关重要。目前，诊断主要集中在脑脊液（CSF）培养上，但这存在很大的局限性。相比之下，宏基因组下一代测序（mNGS）可以克服传统诊断方法的不足。据我们所知，mNGS 分析脑脊液在粪肠球菌脑膜炎的诊断中尚未见报道。
我们报告了一例 70 岁女性粪肠球菌脑膜炎病例，该患者无头部外伤或手术史，但存在蝶窦隐匿性骨缺损。通过 CSF 的 mNGS 诊断为粪肠球菌脑膜炎，经适当抗生素治疗和颅骨骨缺损手术修复后，患者恢复良好。
在颅隐匿性缺损的情况下，非创伤性或术后粪肠球菌脑膜炎也可能发生，在 CSF 培养阳性率低的情况下，mNGS 技术有助于诊断。
