Jin Shanshan, Xie Hui, Wang Ruilan
Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, 200080, People's Republic of China.
Department of Critical Care Medicine, Shanghai General Hospital of Nanjing Medical University, Shanghai, 200080, People's Republic of China.
Infect Drug Resist. 2024 Oct 28;17:4707-4716. doi: 10.2147/IDR.S490828. eCollection 2024.
Community-acquired meningitis (CA-KPM) can rapidly progress to invasive infection in healthy individuals. We present the case of a 54-year-old man with a history of acute suppurative otitis media and uncontrolled type 2 diabetes mellitus (T2DM), who had been treated with oral antibiotics intermittently and irregularly for one month. His symptoms did not improve and continued to worsen, leading to fever and coma. Metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) identified (KP) after 24 hours in the intensive care unit (ICU). Subsequent CSF culture confirmed a hypervirulent KP (hvKp) strain with capsular genotype K2 and sequence type (ST) 375. Fortunately, the patient made a full recovery with targeted antimicrobial therapy and was discharged. Despite the delayed diagnosis, the outcome was favorable. This case highlights the importance of clinicians, particularly otolaryngologists, maintaining a high index of suspicion for CA-KPM in patients with both otitis media and T2DM, emphasizing the need for timely multidisciplinary consultation.
社区获得性肺炎克雷伯菌脑膜炎（CA-KPM）可在健康个体中迅速进展为侵袭性感染。我们报告一例54岁男性病例，该患者有急性化脓性中耳炎病史且2型糖尿病（T2DM）控制不佳，曾间断且不规律地口服抗生素治疗1个月。其症状未改善且持续恶化，导致发热和昏迷。在重症监护病房（ICU）对脑脊液（CSF）进行宏基因组下一代测序（mNGS），24小时后鉴定出肺炎克雷伯菌（KP）。随后的脑脊液培养证实为一株具有K2荚膜基因型和序列类型（ST）375的高毒力肺炎克雷伯菌（hvKp）菌株。幸运的是，患者通过针对性抗菌治疗完全康复并出院。尽管诊断延迟，但结果良好。该病例强调了临床医生，尤其是耳鼻喉科医生，对患有中耳炎和T2DM的患者保持对CA-KPM高度怀疑指数的重要性，强调了及时进行多学科会诊的必要性。
