诱导性脑膜脑炎的诊断挑战与治疗突破:早期宏基因组二代测序(mNGS)应用的真实世界分析
Diagnostic challenges and treatment breakthroughs in -induced meningoencephalitis: a real-world analysis of early mNGS applications.
作者信息
Wang Jian, Tao Lin
机构信息
Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
Disease Prevention and Control Center of Huaxi District, Guiyang, Guizhou, China.
出版信息
Front Cell Infect Microbiol. 2025 Jul 18;15:1613521. doi: 10.3389/fcimb.2025.1613521. eCollection 2025.
BACKGROUND
is a lipid-dependent yeast species that commonly colonizes human and warm-blooded animal skin as an opportunistic pathogen. Although strongly associated with dermatological conditions like seborrheic dermatitis, central nervous system (CNS) infections caused by are remarkably rare. These infections typically present with nonspecific clinical features, leading to frequent diagnostic delays and misdiagnosis.
METHODS
We performed a retrospective analysis of five definitive cases of -induced meningoencephalitis diagnosed at our institution. Comprehensive clinical evaluations included disease onset patterns, symptomatology, laboratory findings, neuroimaging features, therapeutic regimens, and patient outcomes.
RESULTS
All patients exhibited acute onset meningoencephalitis, with headache being the most common presentation symptom, and patients presenting with decreased consciousness showed rapid clinical deterioration. Brain magnetic resonance imaging (MRI) exhibits ring enhancement accompanied by ring diffusion restriction, plays a crucial role in early diagnosis. The cerebrospinal fluid (CSF) demonstrated markedly elevated intracranial pressure and a significant decrease in CSF glucose, vital laboratory markers of critical illness. Metagenomic next-generation sequencing (mNGS) of CSF confirmed infection in all cases, enabling prompt diagnosis. Early combination therapy with intravenous and intrathecal antifungal agents significantly improved survival outcomes.
CONCLUSION
-associated meningoencephalitis represents an extremely rare and life-threatening CNS infectious disease. Since nonspecific early symptoms lead to diagnostic challenges, CSF usually shows a significant increase in intracranial pressure, and a significant decrease in CSF glucose levels may serve as a key laboratory biomarker. Brain MRI demonstrates multiple and diverse intracranial lesions, with ring enhancement accompanied by ring diffusion restriction potentially representing relatively specific imaging features. mNGS of CSF may prove valuable for early diagnosis. Standardized antifungal therapy, particularly early intrathecal administration, may be critical to reducing mortality.
背景
是一种依赖脂质的酵母菌种,常作为机会性病原菌定植于人和温血动物皮肤。尽管与脂溢性皮炎等皮肤病密切相关,但由其引起的中枢神经系统(CNS)感染极为罕见。这些感染通常表现为非特异性临床特征,导致频繁的诊断延迟和误诊。
方法
我们对在本机构确诊的5例由引起的脑膜脑炎确诊病例进行了回顾性分析。全面的临床评估包括疾病发作模式、症状、实验室检查结果、神经影像学特征、治疗方案和患者预后。
结果
所有患者均表现为急性起病的脑膜脑炎,头痛是最常见的症状表现,意识下降的患者临床病情迅速恶化。脑磁共振成像(MRI)表现为环形强化伴环形扩散受限,在早期诊断中起关键作用。脑脊液(CSF)显示颅内压明显升高,CSF葡萄糖显著降低,这是危重病的重要实验室指标。CSF的宏基因组下一代测序(mNGS)在所有病例中均确诊感染,从而实现了快速诊断。静脉和鞘内抗真菌药物的早期联合治疗显著改善了生存结局。
结论
相关的脑膜脑炎是一种极其罕见且危及生命的中枢神经系统感染性疾病。由于早期非特异性症状导致诊断困难,CSF通常显示颅内压显著升高,CSF葡萄糖水平显著降低可能是关键的实验室生物标志物。脑MRI显示颅内有多个不同的病变,环形强化伴环形扩散受限可能代表相对特异的影像学特征。CSF的mNGS可能对早期诊断有价值。标准化抗真菌治疗,尤其是早期鞘内给药,对于降低死亡率可能至关重要。