Yang Nian-Long, Cai Xiao, Que Qing, Zhao Hua, Zhang Kai-Long, Lv Sheng
Department of Critical Care Medicine, Central Hospital of Panzhihua, Panzhihua 617000, Sichuan Province, China.
School of Health and Wellness, Panzhihua University, Panzhihua 617000, Sichuan Province, China.
World J Clin Cases. 2022 Jan 21;10(3):1131-1139. doi: 10.12998/wjcc.v10.i3.1131.
(), which causes central nervous system infections in adults, is very rare. It is also relatively difficult to culture mycoplasma and culturing requires special media, resulting in a high rate of clinical underdiagnosis. Therefore, clinicians often treat patients based on their own experience before obtaining pathogenic results and may ignore infections with atypical pathogens, thus delaying the diagnosis and treatment of patients and increasing the length of hospital stay and costs.
A 44-year-old man presented to the hospital complaining of recurrent dizziness for 1 year, which had worsened in the last week. After admission, brain magnetic resonance imaging (MRI) revealed a 7.0 cm × 6.0 cm × 6.1 cm lesion at the skull base, which was irregular in shape and had a midline shift to the left. Based on imaging findings, meningioma was our primary consideration. After lesion resection, the patient had persistent fever and a diagnosis of suppurative meningitis based on cerebrospinal fluid (CSF) examination. The patient was treated with the highest level of antibiotics (meropenem and linezolid), but the response was ineffective. Finally, was detected by next-generation metagenomic sequencing (mNGS) in the CSF. Therefore, we changed the antibiotics to moxifloxacin 0.4 g daily combined with doxycycline 0.1 g twice a day for 2 wk, and the patient had a normal temperature the next day.
Mycoplasma meningitis after neurosurgery is rare. We can use mNGS to detect in the CSF and then provide targeted treatment.
（）可导致成人中枢神经系统感染，极为罕见。支原体培养也相对困难，培养需要特殊培养基，导致临床漏诊率较高。因此，临床医生在获得病原学结果之前常根据自身经验治疗患者，可能会忽视非典型病原体感染，从而延误患者的诊断和治疗，增加住院时间和费用。
一名44岁男性因反复头晕1年入院，近1周加重。入院后，脑磁共振成像（MRI）显示颅底有一7.0 cm×6.0 cm×6.1 cm病变，形状不规则，中线向左移位。根据影像学表现，我们首先考虑为脑膜瘤。病变切除后，患者持续发热，脑脊液（CSF）检查诊断为化脓性脑膜炎。患者接受了最高级别的抗生素治疗（美罗培南和利奈唑胺），但效果不佳。最后，通过脑脊液下一代宏基因组测序（mNGS）检测到（）。因此，我们将抗生素改为莫西沙星0.4 g每日联合多西环素0.1 g每日2次，共2周，患者次日体温恢复正常。
神经外科手术后支原体脑膜炎罕见。我们可以使用mNGS检测脑脊液中的（），然后进行针对性治疗。
