Ben Salah H, Crockaert F, Levy J, Ferster A, Devalck C, Sariban E
Unité d'hémato-oncologie, hôpital universitaire des enfants, Bruxelles, Belgique.
Arch Pediatr. 1994 Sep;1(9):813-5.
Opportunistic infections are responsible for significant morbidity and mortality in patients with malignancy developing granulocytopenia as a result of therapy. A case of Stomatococcus mucilaginosus meningitis is reported.
A 2 year-old boy was admitted because he had developed fever and neutropenia during chemotherapy given for neuroectodermal tumor. He was previously treated for a Stomatococcus mucilaginosus septicemia with vancomycin given for 15 days through an intravenous catheter which has subsequently been left in place. At admission, fever was associated with severe degree of aplasia (70 WBC/mm3). The patient was given IV ceftazidime plus amikacin. Two days later, the boy developed acute meningitis due to Stomatococcus mucilaginosus; he was then given IV vancomycin (40 mg/kg/d) and imipenem (100 mg/kg/d). Persistence of abnormal clinical and bacteriological findings required subsequent intrathecal administration of vancomycin (1.5 mg/d) for 5 days. CSF cultures were negative 2 days later, leading to stop IV antibiotics after 3 weeks. The catheter was removed 1 week later.
This patient represents the third reported case of Stomatococcus mucilaginosus meningitis. Combined intrathecal and systemic administration of vancomycin seems to have been useful in our case.
机会性感染是因治疗导致粒细胞减少的恶性肿瘤患者发病和死亡的重要原因。本文报告了1例粘质口腔球菌性脑膜炎病例。
一名2岁男孩因在接受神经外胚层肿瘤化疗期间出现发热和中性粒细胞减少而入院。他曾因粘质口腔球菌败血症通过静脉导管接受万古霉素治疗15天，之后导管一直留置。入院时，发热伴有严重的发育不全（白细胞计数70/立方毫米）。给予患者静脉注射头孢他啶加阿米卡星。两天后，该男孩因粘质口腔球菌引发急性脑膜炎；随后给予静脉注射万古霉素（40毫克/千克/天）和亚胺培南（100毫克/千克/天）。由于临床和细菌学检查结果持续异常，随后进行了5天的鞘内注射万古霉素（1.5毫克/天）。两天后脑脊液培养结果为阴性，3周后停用静脉抗生素。1周后拔除导管。
该患者是报告的第3例粘质口腔球菌性脑膜炎病例。在我们的病例中，鞘内和全身联合使用万古霉素似乎有效。
