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一名神经退行性疾病患者并发肠漏综合征及产气荚膜梭菌败血症:病例报告

Leaky Gut Syndrome Along With Clostridium perfringens Bacteremia in a Neurodegenerative Disease Patient: A Case Report.

作者信息

Usuda Daisuke, Sugita Manabu, Shen Pingcheng, Umehara Tadashi, Kitamoto Takeshi

机构信息

Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Nerima, JPN.

Department of Internal Medicine, Hasegawa Hospital, Mitaka, JPN.

出版信息

Cureus. 2024 Dec 7;16(12):e75290. doi: 10.7759/cureus.75290. eCollection 2024 Dec.

Abstract

Leaky gut syndrome (LGS) is caused by intestinal epithelial injury and increased intestinal permeability due to a variety of factors, including chronic stress, inflammatory bowel disease, diabetes, surgery, and chemotherapy, resulting in an increased influx of matter from the intestinal lumen causing constipation and bacteremia. To our knowledge, this is the first known case of LGS along with () bacteremia in a neurodegenerative disease patient. The patient was an 81-year-old male with a history of Alzheimer's disease, cerebral infarction, and diverticulitis in a psychiatric hospital, fed via a nasogastric tube. During hospitalization, he developed a 37.4℃ temperature and disturbance of consciousness evaluated as 3 points on the Glasgow Coma Scale. A follow-up blood examination revealed a white blood cell count of 29,000/µL and a C-reactive protein value of 11.2 mg/dL. Computed tomography revealed an increased concentration of peripheral adipose tissue from the sigmoid colon to the rectum and significant quantities of stool in the rectum. Treatment was initiated with doripenem (DRPM) for sepsis of unknown focus. was subsequently identified in both two blood culture tests. He improved with decreased inflammatory response; DRPM was terminated after 14 days. He remains free of recurrence. We speculate that the LGS in this case may have developed from dopaminergic neuronal decrease and impaired amino acid metabolism caused by chronic hypo-inflammation due to neurodegenerative disease (Alzheimer's disease). We report the first known case of LGS along with bacteremia in a neurodegenerative disease patient.

摘要

肠漏综合征(LGS)是由多种因素导致的肠上皮损伤和肠道通透性增加引起的,这些因素包括慢性应激、炎症性肠病、糖尿病、手术和化疗,从而导致肠腔内物质流入增加,引起便秘和菌血症。据我们所知,这是首例在神经退行性疾病患者中出现的LGS合并()菌血症的病例。该患者为一名81岁男性,有阿尔茨海默病、脑梗死病史,因憩室炎入住精神病医院,通过鼻饲管进食。住院期间,他体温达到37.4℃,意识障碍,格拉斯哥昏迷量表评分为3分。后续血液检查显示白细胞计数为29,000/µL,C反应蛋白值为11.2 mg/dL。计算机断层扫描显示从乙状结肠到直肠的外周脂肪组织浓度增加,直肠内有大量粪便。开始使用多利培南(DRPM)治疗不明原因的败血症。随后在两次血培养检测中均发现了()。他的炎症反应减轻,病情好转;14天后停用DRPM。他未再复发。我们推测该病例中的LGS可能是由神经退行性疾病(阿尔茨海默病)引起的慢性炎症不足导致的多巴胺能神经元减少和氨基酸代谢受损所致。我们报告了首例神经退行性疾病患者中出现的LGS合并()菌血症的病例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ddae/11703780/e26d239936f0/cureus-0016-00000075290-i01.jpg

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