Yao Lin, Chen Sansong, Yu Zuan, Yu Tao
Department of Neurosurgery, The Translational Research Institute for Neurological Disorders, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu, China.
Front Neurol. 2022 Aug 12;13:893627. doi: 10.3389/fneur.2022.893627. eCollection 2022.
Multifocal brain abscesses caused by invasive are relatively rare. Here, we present a 67-year-old male was admitted to the hospital for unconsciousness and fever. The computed tomography (CT) examination showed multiple intracranial space-occupying and "cavity-like" changes in the right lower lung. The examination of cerebrospinal fluid (CSF) was consistent with typical bacterial meningitis, CSF analyses revealed leukocytosis (10,300 × 10/L), elevated protein levels (140.39 mg/dL), decreased glucose levels (0.27 mmol/L), and normal chloride concentration level (120.2 mmol/L), however, pathogens were not detected in the cultures. Then, the CSF and sputum samples were analyzed using meta-genomic next-generation sequencing (mNGS), and was detected in both samples. We adjusted the use of antibiotics according to the results of mNGS in time. After anti-infective treatment, the patient achieved good treatment results in a very short time. This case highlights the mNGS can identify pathogens of brain abscess, and provide strong evidence for clinical diagnosis and treatment strategy.
侵袭性引起的多灶性脑脓肿相对少见。在此,我们报告一名67岁男性因意识不清和发热入院。计算机断层扫描(CT)检查显示右肺下叶有多个颅内占位及“空洞样”改变。脑脊液(CSF)检查符合典型细菌性脑膜炎,脑脊液分析显示白细胞增多(10,300×10/L)、蛋白水平升高(140.39mg/dL)、葡萄糖水平降低(0.27mmol/L)以及氯化物浓度水平正常(120.2mmol/L),然而,培养物中未检测到病原体。随后,使用宏基因组下一代测序(mNGS)对脑脊液和痰液样本进行分析,两个样本中均检测到了[未提及的病原体]。我们根据mNGS结果及时调整了抗生素的使用。经过抗感染治疗,患者在很短时间内取得了良好的治疗效果。该病例突出表明mNGS可识别脑脓肿的病原体,并为临床诊断和治疗策略提供有力依据。