Benhalima Ilyès, Jacquemont Lola, Milière Laurine, Tone Alina, Ettahar Nicolas, Dewulf Gisèle, Mazars Edith
Laboratoire de Microbiologie, Centre Hospitalier de Valenciennes, Valenciennes, F-59300, France.
Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier de Valenciennes, Valenciennes, F-59300, France.
Ann Clin Microbiol Antimicrob. 2024 Dec 18;23(1):106. doi: 10.1186/s12941-024-00765-5.
In June 2022, a 73-year-old man with a history of laryngeal and esophageal carcinoma was admitted to the emergency unit with sudden fever, confusion, and general condition deterioration. Initial assessments showed a fever of 38.5 °C, elevated C-reactive protein (CRP) at 209 mg/L, and a neutrophil count of 10.4 G/L, with negative results for urine analysis, blood cultures, and multiple infectious pathogens, including Legionella pneumophila, pneumococcal antigen, and SARS-CoV-2. Computed tomography (CT) scans revealed no significant infectious focus.Empirical treatment with Ceftriaxone and Ciprofloxacin was initiated. Despite treatment, the patient's condition remained unchanged, and a lumbar puncture revealed turbid cerebrospinal fluid (CSF) with 14,300 white blood cells (WBC)/mm³, predominantly neutrophils, elevated proteins, and decreased glucose. Gram staining suggested Neisseria meningitidis, but further testing was necessary. Antibiotic therapy was switched to Cefotaxime and Dexamethasone, and the patient was transferred to the Tropical and Infectious Disease Unit.Multiplex PCR assays and additional CSF tests were negative for common pathogens. Sequencing of 16S ribosomal RNA identified Gemella sp. The patient's condition improved with continued Cefotaxime treatment, and he recovered without neurological sequelae. Subsequent dental CT revealed poor dental hygiene but no signs of osteo-meningeal breach or bone lysis.A literature review identified 22 reported cases of central nervous system (CNS) infections caused by various Gemella species from 1980 to 2022. Of these, 59% presented with meningitis, and 41% had additional encephalitis or brain abscesses. Complete recovery occurred in 77% of cases, with 9% resulting in neurological damage and another 9% in fatal outcomes. Relapses occurred in 14% of the cases. The review highlighted that CNS infections by Gemella spp. primarily affect immunocompromised adults with ENT (ear nose throat) or neurological breaches, although some cases involved healthy individuals.This case underscores the diagnostic challenges posed by uncommon pathogens like Gemella and highlights the utility of molecular microbiology in identifying causative agents, thus guiding appropriate treatment. The patient's history of ENT and esophageal cancers, along with recent radiotherapy and chemotherapy, likely contributed to the infection's development. The case emphasizes the importance of thorough investigation in febrile confusion cases and the potential role of Gemella spp. in CNS infections.
2022年6月，一名有喉癌和食管癌病史的73岁男性因突发发热、意识模糊和全身状况恶化被收入急诊科。初步评估显示体温38.5℃，C反应蛋白（CRP）升高至209mg/L，中性粒细胞计数为10.4G/L，尿液分析、血培养以及包括嗜肺军团菌、肺炎球菌抗原和严重急性呼吸综合征冠状病毒2（SARS-CoV-2）在内的多种感染病原体检测结果均为阴性。计算机断层扫描（CT）未发现明显感染病灶。开始使用头孢曲松和环丙沙星进行经验性治疗。尽管进行了治疗，患者病情仍未改善，腰椎穿刺显示脑脊液（CSF）浑浊，白细胞（WBC）计数为14300/mm³，以中性粒细胞为主，蛋白升高，葡萄糖降低。革兰氏染色提示为脑膜炎奈瑟菌，但仍需进一步检测。抗生素治疗改为头孢噻肟和地塞米松，患者被转至热带病与传染病科。多重聚合酶链反应（PCR）检测和其他脑脊液检测未发现常见病原体。16S核糖体RNA测序鉴定为孪生球菌属。继续使用头孢噻肟治疗后患者病情好转，康复后无神经后遗症。随后的牙科CT显示口腔卫生状况差，但无骨膜-脑膜破损或骨质溶解迹象。文献综述发现，1980年至2022年期间共报告了22例由各种孪生球菌属引起的中枢神经系统（CNS）感染病例。其中，59%表现为脑膜炎，41%伴有脑炎或脑脓肿。77%的病例完全康复，9%导致神经损伤，9%导致死亡。14%的病例出现复发。该综述强调，孪生球菌属引起的中枢神经系统感染主要影响有耳鼻喉（ENT）疾病或神经破损的免疫功能低下成年人，不过也有一些病例涉及健康个体。本病例强调了像孪生球菌这样的罕见病原体所带来的诊断挑战，并突出了分子微生物学在识别病原体从而指导恰当治疗方面的作用。患者的耳鼻喉癌和食管癌病史，以及近期的放疗和化疗，可能促使了感染的发生。该病例强调了在发热性意识模糊病例中进行全面检查的重要性以及孪生球菌属在中枢神经系统感染中的潜在作用。
