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病例报告:由以厌氧菌为主的口腔微生物混合感染引起的脑膜炎和颅内动脉瘤。

Case report: Meningitis and intracranial aneurysm caused by mixed infection of oral microflora dominated by anaerobes.

作者信息

Cheng Hongjiang, Xu Lina, Yang Fengbing, Jia Longbin, Zhao Doudou, Li Huimin, Liu Wei, Li Yujuan, Liu Xiaoli, Geng Xia, Guo Jiaying, Ling Chen, Zhang Jing

机构信息

Department of Neurology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China.

Department of Rheumatology, Jincheng People's Hospital Affiliated to Shanxi Medical University, Jincheng, China.

出版信息

Front Neurol. 2022 Aug 5;13:889838. doi: 10.3389/fneur.2022.889838. eCollection 2022.

Abstract

INTRODUCTION

Meningitis caused by oral anaerobic bacteria is rare, especially when complicated with an infected intracranial aneurysm. This paper has described an extremely rare case of bacterial meningitis caused by a mixed infection of oral microflora dominated by anaerobes, which developed cerebral infarcts, brain abscess, intracranial aneurysm, and severe hydrocephalus during treatment.

CASE REPORT

We describe a 65-year-old male patient who was presented with fever and headache as the initial symptoms and then developed left ophthalmoplegia, right hemiplegia, and disturbance of consciousness. Brain imaging showed that intracranial lesions were increased progressively, and cerebral infarcts, brain abscesses, intracranial aneurysm, and severe hydrocephalus were appeared gradually. Eventually, we diagnosed it as anaerobic meningitis by making deoxyribonucleic acid sequencing from the brain abscess pus. After using an anti-microbial regimen that can sufficiently cover anaerobes, the patient's condition was effectively controlled.

CONCLUSION

Anaerobic meningitis can cause a series of intracranial complications. Among them, the intracranial aneurysm is extremely rare. When evidence shows that the infection originates from oral flora, physicians should consider the possibility of this type of encephalitis. An early diagnosis and timely treatment are crucial to improving the prognosis.

摘要

引言

由口腔厌氧菌引起的脑膜炎较为罕见,尤其是合并颅内感染性动脉瘤时。本文报道了一例极为罕见的由以厌氧菌为主的口腔微生物群混合感染所致的细菌性脑膜炎病例,该病例在治疗过程中出现了脑梗死、脑脓肿、颅内动脉瘤及严重脑积水。

病例报告

我们描述了一名65岁男性患者,最初症状为发热和头痛,随后出现左侧动眼神经麻痹、右侧偏瘫及意识障碍。脑部影像学检查显示颅内病变逐渐增多,脑梗死、脑脓肿、颅内动脉瘤及严重脑积水逐渐出现。最终,通过对脑脓肿脓液进行脱氧核糖核酸测序,我们将其诊断为厌氧性脑膜炎。在使用能充分覆盖厌氧菌的抗菌治疗方案后,患者病情得到有效控制。

结论

厌氧性脑膜炎可引发一系列颅内并发症。其中,颅内动脉瘤极为罕见。当有证据表明感染源于口腔菌群时,医生应考虑此类脑炎的可能性。早期诊断和及时治疗对改善预后至关重要。

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