Mo Tingting, Wu Fang, Dou Xiangjun, Wang Dong, Xia Han, Li Xia
Department of Pediatric Neurology, Xi'an Children's Hospital, Xi'an, China.
Department of Scientific Affaires, Hugobiotech Co., Ltd., Beijing, China.
Front Neurol. 2022 Mar 2;13:827145. doi: 10.3389/fneur.2022.827145. eCollection 2022.
Listeria meningoencephalitis (LMM) is very rare in healthy children. We aimed to assess the clinical features, differential diagnosis, treatment options, and outcomes of LMM in immunocompetent children through a retrospective study.
The clinical symptoms, laboratory findings, imaging features, antibiotic use, and metagenomic next-generation sequencing (mNGS) results of the cerebrospinal fluid (CSF) were obtained from immunocompetent children who were diagnosed with LMM and admitted to the Xi'an Children's Hospital from May 2018 to July 2020.
The data from 8 immunocompetent children were retrospectively analyzed in this study. The cohort included data from 5 males and 3 females who were aged from 1 year and 7 months to 16 years and 6 months. A total of 4 patients had chilled food before onset. The complications included hyponatremia (3/8), hydrocephalus (2/8), and hemophagocytic syndrome (1/8). In total, 8 patients were diagnosed with by positive CSF culture or mNGS results. The positive rate of CSF culture was 62.5% (5/8). A total of 5 patients conducted CSF mNGS, and the results of the mNGS were positive in 4 patients (80%, 4/5) and suspected in 1 patient. A total of 7 patients changed their therapeutic regimen to combined antibacterial therapies that included linezolid and meropenem (5/8), or ampicillin and meropenem (2/8). A total of 5 patients had favorable outcomes (Glasgow Outcome Scale, GOSE = 5) while two patients had unfavorable outcomes (GOSE = 1) and were complicated with hyponatremia and hydrocephalus.
Listeria meningoencephalitis (LMM) can occur in children with normal immune function and is commonly mistaken for other central nervous system infections. can be quickly and accurately detected by mNGS. Hyponatremia and hydrocephalus may indicate unfavorable outcomes.
李斯特菌脑膜脑炎（LMM）在健康儿童中极为罕见。我们旨在通过一项回顾性研究评估免疫功能正常儿童LMM的临床特征、鉴别诊断、治疗选择及预后。
收集2018年5月至2020年7月在西安市儿童医院确诊为LMM并入院的免疫功能正常儿童的临床症状、实验室检查结果、影像学特征、抗生素使用情况以及脑脊液（CSF）的宏基因组下一代测序（mNGS）结果。
本研究对8例免疫功能正常儿童的数据进行了回顾性分析。该队列包括5名男性和3名女性，年龄从1岁7个月至16岁6个月。共有4例患者在发病前食用过冷藏食品。并发症包括低钠血症（3/8）、脑积水（2/8）和噬血细胞综合征（1/8）。共有8例患者通过CSF培养或mNGS结果确诊。CSF培养阳性率为62.5%（5/8）。共有5例患者进行了CSF mNGS，其中4例患者mNGS结果为阳性（80%，4/5），1例患者结果可疑。共有7例患者将治疗方案改为联合抗菌治疗，包括利奈唑胺和美罗培南（5/8），或氨苄西林和美罗培南（2/8）。共有5例患者预后良好（格拉斯哥预后量表，GOSE = 5），而2例患者预后不良（GOSE = 1），并伴有低钠血症和脑积水。
李斯特菌脑膜脑炎（LMM）可发生于免疫功能正常的儿童，常被误诊为其他中枢神经系统感染。mNGS可快速准确地检测到。低钠血症和脑积水可能提示预后不良。
