Carneiro Bruno Hassunuma, de Melo Thayane Guimarães, da Silva Alessandra Filpo Ferreira, Lopes Júlia Tavares, Ducci Renata Dal-Prá, Carraro Junior Hipólito, Ducroquet Marcelo Abreu, França João Cesar Beenke
Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil.
Infez Med. 2023 Dec 1;31(4):570-574. doi: 10.53854/liim-3104-16. eCollection 2023.
Listeriosis is a known cause of community acquired bacterial meningitis/meningoencephalitis. It occurs more frequently in neonates, older people and immunocompromised hosts. Rarely, brain abscesses can complicate the course of infection, which poses a difficulty in the management and elevates morbidity and mortality. Myasthenia gravis is an autoimmune disease that often requires immunosuppressive treatment, which increases the risk for invasive infections.
A 75-year-old myasthenic patient, treated with prednisone and pyridostigmine, was diagnosed with invasive listeriosis. He presented with muscle weakness, dyspnea, hemiparesis and altered mental status. Brain imaging revealed multiple abscesses and blood cultures were positive for . Despite combination antibiotic therapy, he died 6 weeks after admission.
Ninety-six cases of brain abscesses from 1968 to 2023 were reviewed; the majority of the patients were men, 54 years-old on average, and had at least one risk factor for invasive listeriosis. The mortality exceeded 22%. Blood cultures and CSF/abscess cultures were positive in only 79.2% and 54.6%, respectively. The most common therapeutic approach was a combination regimen that included amoxicillin or ampicillin. Only 8 patients underwent surgery, of which one died.
This case highlights the importance of as a cause of brain abscesses in populations at risk, including myasthenic patients. The challenge of diagnosing and treating this condition is aggravated by the paucity of literature and the high mortality rate.
李斯特菌病是社区获得性细菌性脑膜炎/脑膜脑炎的已知病因。它在新生儿、老年人和免疫功能低下的宿主中更常见。脑脓肿很少会使感染病程复杂化，这给治疗带来困难并增加发病率和死亡率。重症肌无力是一种自身免疫性疾病，通常需要免疫抑制治疗，这会增加侵袭性感染的风险。
一名75岁的重症肌无力患者，接受泼尼松和吡啶斯的明治疗，被诊断为侵袭性李斯特菌病。他出现肌肉无力、呼吸困难、偏瘫和精神状态改变。脑部影像学检查发现多个脓肿，血培养阳性。尽管采用了联合抗生素治疗，他在入院6周后死亡。
对1968年至2023年的96例脑脓肿病例进行了回顾；大多数患者为男性，平均年龄54岁，且至少有一项侵袭性李斯特菌病的危险因素。死亡率超过22%。血培养和脑脊液/脓肿培养的阳性率分别仅为79.2%和54.6%。最常见的治疗方法是联合使用包括阿莫西林或氨苄西林在内的方案。只有8例患者接受了手术，其中1例死亡。
本病例强调了[原文此处缺失内容]作为包括重症肌无力患者在内的高危人群脑脓肿病因的重要性。文献的匮乏和高死亡率加剧了诊断和治疗这种疾病的挑战。
