Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan City, China.
Department of Pathology and Pathophysiology, Shandong Medical College, Jinan City, China.
BMC Infect Dis. 2024 Oct 13;24(1):1150. doi: 10.1186/s12879-024-10035-6.
Pantoea agglomerans (P. agglomerans) is a gram-negative bacterium that is commonly isolated from plant surfaces, seeds, and the environment. As an opportunistic pathogen, it can cause blood, urinary and soft tissue infections in immunocompromised patients. In central nervous system, P. agglomerans infection has been report in children and immune-compromised patients, however, infection by such bacterium in nontraumatized immune competent adults has not been reported. Here, we report a case of P. agglomerans cerebrospinal meningitis accompanied by positive anti-myeloperoxidase (MPO) antibody in a 49-year-old female who has a history of black fungus planting.
The patient manifested with repeated fever, headache, generalized muscle pain, and neurological defects. Cerebrospinal fluid (CSF) tests revealed a moderately elevated number of polymorphonuclear leukocytes (50-193 × 10/L), low glucose levels (0.54-2.44 mmo1/L), and extremely high protein content (2.42-25.42 g/L). Blood tests showed positive anti-myeloperoxidase antibodies lasting for 1.5 year before turning negative. Spine MRI showed thickening and enhancement of the whole spinal meninges. CSF metagenomic next-generation sequencing (mNGS) revealed 75,189 specific DNA reads of P. agglomerans. The patient underwent spinal laminectomy due to meningeal adhesions. Pathological results revealed fibrous tissue proliferation, inflammatory infiltration with focal necrosis and calcification in the dura mater. The patient was successfully treated with sufficient antibiotics at 1-year follow-up.
People should be alert to CNS infections caused by P. agglomerans which presented with relatively mild clinical symptoms at onset, especially for those who contucts relevant agricultural and forestry work. The CSF characterization of P. agglomerans meningitis is elevated multiple nuclei white blood cells, significantly reduced glucose content, and markedly increased protein level which may be related to the secondary spinal membrane adhesions.
成团泛菌（Pantoea agglomerans，P. agglomerans）是一种革兰氏阴性细菌，通常从植物表面、种子和环境中分离出来。作为一种机会性病原体，它可引起免疫功能低下患者的血液、尿液和软组织感染。在中枢神经系统中，成团泛菌感染已在儿童和免疫功能低下患者中报道，但在非创伤性免疫功能正常的成年人中尚未报道。在这里，我们报告了一例成团泛菌脑膜炎病例，该病例伴有抗髓过氧化物酶（MPO）抗体阳性，患者为有黑木耳种植史的 49 岁女性。
患者表现为反复发热、头痛、全身肌肉疼痛和神经功能缺损。脑脊液（CSF）检查显示多形核白细胞中度升高（50-193×10/L），葡萄糖水平低（0.54-2.44mmol/L），蛋白质含量极高（2.42-25.42g/L）。血液检查显示抗髓过氧化物酶抗体阳性，持续 1.5 年，随后转为阴性。脊柱 MRI 显示整个脊髓脑膜增厚和增强。CSF 宏基因组下一代测序（mNGS）显示成团泛菌的 75,189 个特异性 DNA 读段。由于脑膜粘连，患者接受了脊柱椎板切除术。病理结果显示硬脑膜纤维组织增生，炎症浸润伴局灶性坏死和钙化。患者在 1 年随访时接受了足够的抗生素治疗，结果成功。
人们应该警惕成团泛菌引起的中枢神经系统感染，这种感染在发病时表现出相对较轻的临床症状，特别是对于从事相关农林工作的人群。成团泛菌性脑膜炎的 CSF 特征为多核白细胞升高、葡萄糖含量显著降低、蛋白质水平显著升高，这可能与继发性脊髓膜粘连有关。
