Li Qinghua, Fan Xiaotong, Wang Kailiang, Wu Xiaolong, Li Junjie, An Yang, Wei Penghu, Shi Wenli, Shan Yongzhi, Chen Sichang, Zhao Guoguang
Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China.
BMC Infect Dis. 2025 Aug 19;25(1):1042. doi: 10.1186/s12879-025-11479-0.
Aggregatibacter species are Gram-negative bacteria typically recognized as oral saprophytes in humans, with invasive infections uncommon in immunocompetent individuals. To the best our knowledge, this is the first reported case of subdural empyema attributed to Aggregatibacter segnis (A. segnis).
A 50-year-old female was transferred to our hospital from a local facility due to headache, fever, and left-sided limb numbness. Initially suspected of subdural hematoma and viral encephalitis, she did not respond well to prior treatment. Cerebral computed tomography and magnetic resonance imaging revealed a subdural lesion in the frontal-temporal region and sinusitis. Virus-related tests, smear, and culture of cerebrospinal fluid (CSF) were negative. Craniotomy was performed to evacuate the subdual empyema, and A. segnis was detected in the culture of pus. The discrepancy between metagenomic next-generation sequencing (mNGS) and culture highlights diagnostic challenges in this pretreated patient. Antibiotic treatment was guided by culture results and mNGS. Clinical symptoms resolved gradually following surgery and administration of antibiotics.
This rare case suggested that A. segnis should be considered in the diagnosis of subdural empyema. Multimodal diagnostics, prompt neurosurgical management, and individualized antimicrobial stewardship are crucial in managing rare central nervous system infections.
聚集杆菌属是革兰氏阴性菌，通常被认为是人类口腔腐生菌，在免疫功能正常的个体中侵袭性感染并不常见。据我们所知，这是首例报道的由迟钝聚集杆菌（A. segnis）引起的硬脑膜下积脓病例。
一名50岁女性因头痛、发热和左侧肢体麻木从当地医疗机构转入我院。最初怀疑为硬脑膜下血肿和病毒性脑炎，她对先前的治疗反应不佳。脑部计算机断层扫描和磁共振成像显示额颞区有硬脑膜下病变及鼻窦炎。病毒相关检测、脑脊液涂片和培养均为阴性。进行了开颅手术以清除硬脑膜下积脓，脓液培养中检测到迟钝聚集杆菌。宏基因组下一代测序（mNGS）与培养结果之间的差异凸显了该预处理患者的诊断挑战。抗生素治疗根据培养结果和mNGS进行指导。手术后及使用抗生素后临床症状逐渐缓解。
这一罕见病例提示，在硬脑膜下积脓的诊断中应考虑迟钝聚集杆菌。多模式诊断、及时的神经外科处理和个体化的抗菌管理对于处理罕见的中枢神经系统感染至关重要。
