Clinical analysis of misdiagnosis in adult central nervous system infections due to Listeria monocytogenes
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摘要:
背景 中枢神经系统单核细胞增生李斯特菌感染(Listeria monocytogenes infection，LMI)常与多种疾病临床表现类似，极易误诊。 目的 结合文献分析我中心成年人中枢神经系统LMI的临床特点和误诊原因，提高诊断率。 方法 回顾性分析2018-2022年我中心收治的成年人中枢神经系统LMI患者，总结患者的误诊情况并分析原因，并通过文献复习，总结国内外成年人中枢神经系统LMI误诊患者临床资料。 结果 我中心共收治7例中枢神经系统LMI患者，均以发热、头痛为主诉就诊，部分患者伴呼吸衰竭和意识障碍。7例均通过病原学检测确诊，但早期均被误诊。其中误诊为上呼吸道感染5例，病毒性脑膜炎3例，结核性脑膜炎4例，误诊时间为(9.4 ± 4.8) d。患者多采用利福平 + 喹诺酮 + 磺胺类药物治疗，5例完全恢复，2例遗留后遗症。文献复习发现目前国内外共47例较完整的误诊患者资料，绝大多数患者通过脑脊液培养确诊。关于误诊疾病的类型，文献中以颅内感染最常见，其次为内科系统疾病和其他类型疾病，误诊中位时间11(1.5 ~ 95) d，给予青霉素等药物治疗后多数患者预后良好。 结论 中枢神经系统LMI临床表现和辅助检查常不典型，临床医生应提高认识，减少或避免误诊。 -
关键词:
- 中枢神经系统感染 /
- 单核细胞增生李斯特菌 /
- 误诊 /
- 颅内感染 /
- 脑脊液培养
Abstract:Background The manifestations of central nervous system Listeria monocytogenes infection (LMI) are often similar to those of various diseases and are easily to be misdiagnosed. Objective To analyze the clinical characteristics and misdiagnosed causes of adult central nervous system LMI in our hospital and reported in literatures, in order to improve the diagnostic accuracy. Methods A retrospective analysis on clinical data about adult patients with central nervous system LMI who were admitted to our hospital from 2018 to 2022 was conducted to summarize the information of misdiagnosed patients and analyze the causes. Clinical profiles of misdiagnosed adult central nervous system LMI patients were summarized by database retrieval. Results A total of 7 patients with central nervous system LMI were admitted to our hospital, all of whom presented with fever and headache as the chief complaint, and some of them suffered from respiratory failure and consciousness disorder. The patients were diagnosed by microbiological tests. All of them were misdiagnosed at the early stage of the disease, of which 5 cases were diagnosed as upper respiratory tract infection, 3 cases as viral meningitis and 4 cases as tuberculous meningitis. The duration of misdiagnosis was (9.4 ± 4.8) d. Patients were mainly treated with rifampicin, quinolone and sulfanilamide. Five patients were recovered completely, two patients had sequelae. Totally 47 cases of misdiagnosed patients were found in literature reports, and most of them were diagnosed by cerebrospinal fluid culture. As for the types of misdiagnosed diseases, intracranial infection was the most common, followed by internal medicine diseases and other types of diseases. The median number of misdiagnosis days was 11(1.5-95) d. Most patients had a good prognosis after treatment with penicillin and other drugs. Conclusion The clinical manifestations and auxiliary examinations of LMI in central nervous system are often atypical. Clinicians should improve the understanding of the disease and reduce or avoid the misdiagnosis. -
表 1 中枢神经系统单核细胞增生李斯特菌感染患者临床资料
Table 1. Clinical data about patients with central nervous system infections due to Listeria monocytogenes
临床特点 患者1 患者2 患者3 患者4 患者5 患者6 患者7 年龄/岁 52 59 68 47 56 31 46 性别 女 男 男 男 女 女 男 既往史 体健 陈旧性肺结核 高血压 高血压，冠心病 多发性肌炎a 系统性红斑狼疮a 高血压 诱发因素 无 不洁饮食 受凉 无 无 无 无 病程/d 8 6 17 3 11 8 8 临床表现 发热，头痛，
恶心，呕吐发热，头痛，
恶心，呕吐发热，头痛，意识
障碍，呼吸衰竭，
精神症状发热，头痛 发热，头痛，
恶心，呕吐发热，头痛，
抽搐，呼吸衰竭发热，头痛，恶心，
呕吐，意识障碍，
精神症状，耳鸣神经系统查体
阳性体征脑膜刺激征 脑膜刺激征 昏迷，肌力下降，
病理征，脑膜刺激征脑膜刺激征 听力下降，肌力下降 失语，凝视，右侧CNⅦ
麻痹，肌力下降，病理征昏迷，眼球震颤，左侧
CNⅢ、Ⅴ、Ⅶ麻痹，
脑膜刺激征最高体温/℃ 40 38 39.5 38.5 40 39 39.5 诊断 Lm脑膜炎 Lm脑膜炎 Lm脑膜脑炎，脑室脓肿 Lm脑膜炎 Lm脑膜炎 Lm脑脓肿 Lm脑膜脑炎，脑室脓肿 误诊疾病 URI，VM，TBM URI，TBM VM，肺部感染 VM URI，TBM URI URI，TBM 外院是否腰穿 是 是 是 否 否 是 否 治疗 QN，RIF，SMX QN，RIF，SMX QN，RIF，SMX QN，RIF，SMX LZD，RIF QN，SMX，LZD LZD，QN，RIF a患者长期服用激素和免疫抑制剂；CN：脑神经；Lm：单核细胞增生李斯特菌；URI：上呼吸道感染；VM：病毒性脑膜炎；TBM：结核性脑膜炎；QN：喹诺酮；RIF：利福平；SMX：复方新诺明；LZD：利奈唑胺。 
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表 2 中枢神经系统单核细胞增生李斯特菌感染患者主要化验结果
Table 2. Main laboratory results of patients with central nervous system infections due to Listeria monocytogenes
实验室检查 患者1 患者2 患者3 患者4 患者5 患者6 患者7 $\bar x \pm s $/Md 白细胞/(L-1，×109) 8.32 26.9 8.14 19.37 10.03 19.5 6.94 14.2 ± 7.7 IL-6/(pg·mL-1) 6.27 521 15.88 344.1 70.65 125.7 20.48 70.65 CRP/(mg·dL-1) 4.35 21.98 2.36 11.14 14.86 17.44 2.87 10.7 ± 7.8 血沉/(mm·h-1) 78 48 45 64 73 10 115 61.9 ± 32.6 降钙素原/(ng·mL-1) 未查 0.049 未查 0.617 1.03 0.394 4.7 0.617 低钠血症 是 否 否 否 否 是 是 - 颅内压/mmH2O ＞330 ＞330 270 ＞330 300 ＞330 240 ＞330 脑脊液白细胞/(L-1，×106) 17 210 310 460 1266 1530 2 010 829 ± 766.5 脑脊液葡萄糖/(mmol·L-1) 0.79 0.5 2.3 1.8 4.4 2.9 1.39 2.0 ± 1.3 脑脊液氯化物/(mmol·L-1) 113 106.6 108.28 99 104.1 110.1 120.7 108.8 ± 6.9 脑脊液蛋白/(g·L-1) 2.38 2.59 2.74 1.72 1.97 1.57 0.72 2.0 ± 0.7 微生物病原学 阳性ab 阳性a 阳性ac 阳性ab 阳性a 阳性abc 阳性a - IL-6：白细胞介素-6；CRP：C-反应蛋白；a脑脊液二代测序；b脑脊液培养；c血培养。
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[1] Koopmans MM,Brouwer MC,Bijlsma MW,et al. Listeria monocytogenes sequence type 6 and increased rate of unfavorable outcome in meningitis:epidemiologic cohort study[J]. Clin Infect Dis,2013,57(2): 247-253. doi: 10.1093/cid/cit250 [2] Ueno A, Ikawa M, Maeda K, et al. A case of persistent severe cerebral edema with neutrophil infiltration following Listeria meningitis［J/OL］. https://doi.org/10.2169/internalmedicine.8291-21. [3] Paciorek M,Bieńkowski C,Krogulec D,et al. Differences and similarities in clinical manifestations of Listeria monocytogenes and Mycobacterium tuberculous meningitis[J]. Przegl Epidemiol,2020,74(2): 326-335. [4] Vettas C,Dimosiari A,Kydona C,et al. Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis[J]. Mediterr J Rheumatol,2020,31(2): 220-223. doi: 10.31138/mjr.31.2.220 [5] Chen SS,Meng FZ,Sun XW,et al. Epidemiology of human listeriosis in China during 2008-2017[J]. Foodborne Pathog Dis,2020,17(2): 119-125. doi: 10.1089/fpd.2019.2683 [6] Zeighami H,Roudashti S,Bahari S,et al. Frequency of etiological agents of acute bacterial meningitis using culture and polymerase chain reaction assay[J]. New Microbes New Infect,2021,43: 100930. doi: 10.1016/j.nmni.2021.100930 [7] Pan XB,Wang ZX,Ma MH,et al. Clinical case report on treatment of Listeria monocytogenes meningoencephalitis:Intrathecal injection[J]. Clin Case Rep,2018,6(9): 1845-1848. doi: 10.1002/ccr3.1747 [8] Lan ZW,Xiao MJ,Guan YL,et al. Detection of Listeria monocytogenes in a patient with meningoencephalitis using next-generation sequencing:a case report[J]. BMC Infect Dis,2020,20(1): 721. doi: 10.1186/s12879-020-05447-z [9] Ogunleye OO,Karimi V,Gujadhur N. Listeria bacteremia presenting with cerebral abscess and endocarditis in an elderly patient with chronic immune thrombocytopenia[J]. Cureus,2021,13(7): e16601. [10] Magiar O,Vulpie S,Musuroi C,et al. Listeria monocytogenes meningitis in an immunocompetent patient[J]. Infect Drug Resist,2022,15: 989-994. doi: 10.2147/IDR.S351132 [11] Cao LM,Lin YW,Jiang HL,et al. Severe invasive Listeria monocytogenes rhombencephalitis mimicking facial neuritis in a healthy middle-aged man:a case report and literature review[J]. J Int Med Res,2021,49(1): 300060520982653. [12] 刘美兰,许飞. 产单核细胞李斯特菌感染1例护理[J]. 实用临床医学,2011,12(10): 66. doi: 10.3969/j.issn.1009-8194.2011.10.032 [13] 胡雪. 产单核细胞李斯特菌脑膜炎误诊为结核性脑膜炎1例并文献分析[J]. 浙江中西医结合杂志,2014,24(7): 626-628. [14] 郭永征,朱彪,梁伟峰,等. 成人产单核细胞李斯特菌脑膜炎五例临床分析[J]. 中华临床感染病杂志,2015,8(2): 147-149. [15] 张玉想,王宇,王晓丹,等. 单核细胞增多性李斯特菌脑干脑炎一例并文献复习[J]. 中华临床医师杂志(电子版),2015,9(23): 4491-4496. [16] 魏冕,程丽妞,张亚恒. 单核细胞增生李斯特菌脑膜炎两例报道并文献复习[J]. 实用心脑肺血管病杂志,2019,27(11): 114-117. [17] 黄梅会,吴华,苏屿,等. 1例单增李斯特菌误诊病例分析并文献复习[J]. 中国人兽共患病学报,2020,36(1): 75-79. [18] 刘全生,张雯凌,罗家明,等. 产单核细胞李斯特菌致成人脑膜脑炎型败血症2例报道并文献复习[J]. 中国临床神经科学,2017,25(2): 198-200. doi: 10.3969/j.issn.1008-0678.2017.02.010 [19] 张冉,付贺飞,牛云梅,等. 成功治疗2例单核细胞增多性李斯特菌脑干脑炎并文献复习[J]. 中风与神经疾病杂志,2018,35(4): 342-344. [20] 郭益群,尹玉东,王春雷,等. 成人单核细胞增生李斯特菌脑膜炎3例并文献复习[J]. 首都医科大学学报,2017,38(1): 122-125. doi: 10.3969/j.issn.1006-7795.2017.01.025 [21] 付素芬,潘陈为,周光耀. 单核细胞增多性李斯特菌脑膜炎一例[J]. 中华传染病杂志,2007,25(10): 583. doi: 10.3760/j.issn:1000-6680.2007.10.018 [22] 李佳,田卓民. 单核细胞增生李斯特菌脑膜炎1例[J]. 中国感染与化疗杂志,2018,18(2): 206-208. [23] 陈学兵. 单核细胞增生李斯特菌血流感染并发脑膜炎脑梗死1例[J]. 中国感染与化疗杂志,2015,15(2): 178-179. doi: 10.3969/j.issn.1009-7708.2015.02.015 [24] 蔡媛媛. 单核细胞增生李斯特菌致脑膜炎1例[J]. 临床军医杂志,2013,41(1): 105. doi: 10.3969/j.issn.1671-3826.2013.01.056 [25] 魏建华, 张冰美. 单核细胞增生性李斯特菌脑膜炎误诊为结核性脑膜炎一例［C］. 北京: 中国防痨协会第33届全国学术大会, 2021. [26] 梁瑞娟,韩潇,罗玲,等. 开放性肺结核合并李斯特菌脑膜炎一例[J]. 中华内科杂志,2014,53(3): 218-219. doi: 10.3760/cma.j.issn.0578-1426.2014.03.018 [27] 杨扬,吴卫平,崔芳,等. 李斯特菌脑膜脑炎1例报道并文献复习[J]. 中国神经免疫学和神经病学杂志,2016,23(5): 339-343. doi: 10.3969/j.issn.1006-2963.2016.05.008 [28] 李珍大,王丽华,张小卫,王卫萍,邵海枫. 产单核细胞李斯特菌致化脓性脑膜炎2例[J]. 中华检验医学杂志,2002,25(5): 292. doi: 10.3760/j:issn:1009-9158.2002.05.024 [29] 花菲菲,侯炳辉,谢安木. 李斯特菌脑膜脑炎1例报告[J]. 中国神经精神疾病杂志,2017,43(9): 567-569. doi: 10.3969/j.issn.1002-0152.2017.09.014 [30] 张媛媛,邓丽影. 李斯特菌脑膜脑炎一例[J]. 中华神经科杂志,2009,42(11): 726. doi: 10.3760/cma.j.issn.1006-7876.2009.11.003 [31] 王萍,魏红璐,展群岭,等. 重症单核细胞增生型李斯特菌性脑干脑膜脑炎的特点及转归[J]. 检验医学与临床,2014,11(13): 1776-1777. doi: 10.3969/j.issn.1672-9455.2014.13.014 [32] 王玉芬,王兰竹. 李斯特氏菌脑膜炎一例报告[J]. 中华传染病杂志,1986,4(4): 235. [33] 周志平,谢扬新,秦恩强,等. 慢加急性肝功能衰竭并发李斯特菌败血症、腹膜炎及脑膜脑炎1例[J]. 疑难病杂志,2013,12(11): 886. doi: 10.3969/j.issn.1671-6450.2013.11.025 [34] 靳晓利. 免疫功能正常的单核李斯特菌脑膜炎1例报道并文献复习[J]. 黑龙江医学,2019,43(11): 1396-1398. doi: 10.3969/j.issn.1004-5775.2019.11.050 [35] 赵蕾,高岱佺,宿英英. 误诊为脑干梗死的单核细胞增生李斯特菌颅内感染1例报告[J]. 北京医学,2018,40(5): 487-488. [36] 张弥兰,冯淑曼,黄月,等. 系统性红斑狼疮并单核细胞增生李斯特菌感染性脑膜炎一例[J]. 脑与神经疾病杂志,2017,25(9): 561-565. [37] 宋鹏,司延芳,师传帅,等. 系统性红斑狼疮并发产单核细胞李斯特菌脑膜炎1例报道[J]. 重庆医科大学学报,2017,42(12): 1572-1574. [38] 杨变转,李晓彦,翟守恒,等. 严重李斯特菌脑膜炎一例临床分析并文献复习[J]. 山西医药杂志,2018,47(22): 2715-2718. doi: 10.3969/j.issn.0253-9926.2018.22.032 [39] 刘袁媛,张文宏,王冯滨. 重症单核细胞增多性李斯特菌脑膜脑炎1例[J]. 微生物与感染,2011,6(3): 153-157. doi: 10.3969/j.issn.1673-6184.2011.03.006 [40] DeJesus-Alvelo I,Merenda A. A case report of Listeria monocytogenes abscesses presenting as cortically predominant ring-enhancing lesions[J]. Case Rep Neurol,2015,7(1): 105-109. doi: 10.1159/000430434 [41] Gaini S, Karlsen GH, Nandy A, et al. Culture negative Listeria monocytogenes meningitis resulting in hydrocephalus and severe neurological sequelae in a previously healthy immunocompetent man with penicillin allergy［J/OL］. https://doi.org/10.1155/2015/248302. [42] Tiri B, Priante G, Saraca LM, et al. Listeria monocytogenes brain abscess: controversial issues for the treatment-two cases and literature review［J/OL］. https://doi.org/10.1155/2018/6549496. [43] Décard BF,Thöne J,Haghikia A,et al. Listeria rhombencephalitis mimicking a demyelinating event in an immunocompetent young patient[J]. Mult Scler,2017,23(1): 123-125. doi: 10.1177/1352458516650522 [44] 王玉芬,张新民,王兰竹. 李斯特氏菌脑膜炎误诊为出血热[J]. 河南医药,1984,4(1): 13-14. [45] Charlier C,Perrodeau É,Leclercq A,et al. Clinical features and prognostic factors of listeriosis:the MONALISA national prospective cohort study[J]. Lancet Infect Dis,2017,17(5): 510-519. doi: 10.1016/S1473-3099(16)30521-7 [46] 魏超霞,周鹏程,叶倩倩,等. 李斯特菌病患者的临床特征[J]. 中南大学学报(医学版),2021,46(3): 257-262. doi: 10.11817/j.issn.1672-7347.2021.200399 [47] Fujio M,Watanabe T,Morishita N,et al. Perianal abscess caused by Listeria monocytogenes[J]. Intern Med,2022,61(4): 581-583. doi: 10.2169/internalmedicine.7755-21 [48] Xu JL,Gao F,Yuan ZF,et al. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) associated with bacteria meningitis caused by Listeria monocytogenes:a case report[J]. Medicine (Baltimore),2018,97(30): e11561. [49] Schlech WF. Epidemiology and clinical manifestations of Listeria monocytogenes infection［J/OL］. https://doi.org/10.1128/microbiolspec.gpp3-0014-2018. [50] Schutte CM,van der Meyden CH,Kakaza M,et al. Life-threatening Listeria meningitis:need for revision of South African acute bacterial meningitis treatment guidelines[J]. Suid Afrikaanse Tydskrif Vir Geneeskunde,2019,109(5): 296-298. [51] Sunwoo JS,Shin HR,Lee HS,et al. A hospital-based study on etiology and prognosis of bacterial meningitis in adults[J]. Sci Rep,2021,11(1): 6028. doi: 10.1038/s41598-021-85382-4 [52] Cunha BA,Fatehpuria R,Eisenstein LE. Listeria monocytogenes encephalitis mimicking Herpes Simplex virus encephalitis:the differential diagnostic importance of cerebrospinal fluid lactic acid levels[J]. Heart Lung,2007,36(3): 226-231. doi: 10.1016/j.hrtlng.2007.01.001 [53] van de Beek D,Cabellos C,Dzupova O,et al. ESCMID guideline:diagnosis and treatment of acute bacterial meningitis[J]. Clin Microbiol Infect,2016,22(Suppl 3): S37-S62. [54] Young N,Thomas M. Meningitis in adults:diagnosis and management[J]. Intern Med J,2018,48(11): 1294-1307. doi: 10.1111/imj.14102 -
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