Severe brain co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China.
Severe brain co-infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a young, otherwise healthy student recently immigrated from China.
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一名刚从中国移民的健康年轻学生，脑部严重同时感染新型隐球菌和结核分枝杆菌。
DOI：
10.1016/j.ijid.2007.09.009
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发表时间：
2008
期刊：
影响因子：
--
通讯作者：
L. Calza
中科院分区：
文献类型：
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作者：
R. Manfredi;L. Calza
引言虽然肺结核和肺外结核的发病率在高龄患者、免疫功能低下的受试者和来自发展中国家的移民中不断增加[Keller A, Delavelle J, Howarth N, Bianchi S, Garcia J. 亚洲移民的脊柱和神经结核。 JBR-BTR 2002；85：136–7； Sabbatani S、Manfredi R、Legnani G. Chiodo F. 意大利北部大都市区的结核病：流行病学趋势和公共卫生问题。 Eur J Epidemiol 2004;19:501–3]，在年轻且其他健康的患者中，没有明显的免疫缺陷原因且没有明显的暴露，同时发生脑隐球菌病和脑结核和呼吸道结核的情况极为罕见[Silber E, Sonnenberg P, Koornhof HJ, Morris L, Saffer D. 隐球菌脑膜炎患者的双重感染病理学。 Neurology 1998;51:1213–5.].病例报告描述了一个极其罕见的中枢神经系统同时感染新型隐球菌和结核分枝杆菌的病例，该病例是一名 25 岁的健康中国学生，他最近参加了意大利博士后课程。还描述了在五个月的住院期间遇到的诊断和治疗困难，当时仅检测到短暂和/或可忽略的免疫系统损伤。结论这种非常罕见的并发感染事件应该强调需要保持对机会性感染和结核病的高度临床怀疑，即使没有明显的免疫缺陷和相关的流行病学线索。
INTRODUCTIONWhile the incidence of pulmonary and extrapulmonary tuberculosis is growing in patients of advanced age, immunocompromised subjects, and immigrants coming in from developing countries [Keller A, Delavelle J, Howarth N, Bianchi S, Garcia J. Spinal and neurotuberculosis in an Asian immigrant. JBR-BTR 2002;85:136–7; Sabbatani S, Manfredi R, Legnani G. Chiodo F. Tuberculosis in a metropolitan area of northern Italy: epidemiological trends and public health concerns. Eur J Epidemiol 2004;19:501–3], the concomitant occurrence of cerebral cryptococcosis plus brain and respiratory tuberculosis in a young and otherwise healthy patient, without an evident cause of immunodeficiency and without an obvious exposure, is exceedingly rare [Silber E, Sonnenberg P, Koornhof HJ, Morris L, Saffer D. Dual infective pathology in patients with cryptococcal meningitis. Neurology 1998;51:1213–5.].CASE REPORTAn exceptionally rare case of concurrent central nervous system infection with Cryptococcus neoformans and Mycobacterium tuberculosis in a 25-year-old otherwise healthy Chinese student, who had very recently joined an Italian post-doctoral course, is described. Also described are the diagnostic and therapeutic difficulties encountered in a five-month hospitalization period, when only transient and/or negligible immune system impairments were detected.CONCLUSIONSThis episode of very infrequent concurrent infections should emphasize the need to maintain an elevated clinical suspicion for opportunistic infections and tuberculosis, even in the absence of an obvious immunodeficiency and related epidemiological clues.