Worapongsatitaya Pichaya Tao, Pupaibool Jakrapun
Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
Division of Infectious Diseases, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
IDCases. 2022 Jul 20;29:e01577. doi: 10.1016/j.idcr.2022.e01577. eCollection 2022.
Central nervous system (CNS) infection from () is rare and usually occurs in immunosuppressed patients or in a presence of invasive CNS devices. Our case reported here is a very rare case of an immunocompetent elderly patient without any CNS devices who was diagnosed with meningoencephalitis and bacteremia. According to our patient, preceding gastrointestinal (GI) symptoms and trans-sphenoidal hypophysectomy could be the precipitating factors. A positive blood culture should not be concluded as a contamination but prompt repeating another set of blood culture for a better clinical judgment. Given its abrupt clinical course and high mortality rate, high index of suspicion for rapid detection and management is needed for a preferable clinical outcome. Empiric treatment with intravenous vancomycin is reasonable before a susceptibility result becomes available.
由（）引起的中枢神经系统（CNS）感染较为罕见，通常发生在免疫功能低下的患者或存在侵入性CNS装置的情况下。我们在此报告的病例是一例非常罕见的免疫功能正常的老年患者，无任何CNS装置，却被诊断为脑膜脑炎和菌血症。据我们的患者所述，先前的胃肠道（GI）症状和经蝶窦垂体切除术可能是诱发因素。血培养阳性不应被判定为污染，而应及时重复进行另一组血培养，以便做出更好的临床判断。鉴于其临床病程急骤且死亡率高，为获得更好的临床结果，需要高度怀疑以进行快速检测和处理。在药敏结果出来之前，经验性静脉使用万古霉素治疗是合理的。
