A pediatric case of previously unrecognized Streptococcus periodonticum -associated meningitis after cranial surgery.
A pediatric case of previously unrecognized Streptococcus periodonticum -associated meningitis after cranial surgery.
复制标题
开颅手术后先前未被识别的牙周链球菌相关脑膜炎的儿科病例。
DOI：
10.1097/inf.0000000000003787
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发表时间：
2023
影响因子：
3.6
通讯作者：
Kusuhara K
中科院分区：
文献类型：
--
作者：
Nagashio H;Yoneda T;Hoshina T;Saito R;Kusuhara K
一个以前健康的6岁男孩接受了内镜鼻内经蝶窦手术（ETSS）颅咽管瘤。患者术后第2天出现脑脊液（CSF）鼻漏，术后第3天预防性给予头孢噻肟。POD 6时，患者出现发热、呕吐、头痛（图1）。外周血白细胞、中性粒细胞计数和血清c反应蛋白水平分别为14.8× 109/L、11.7× 109/L和83.4 mg/L。脑脊液分析显示多细胞增多（2294个/mL），多核细胞占98.3%。经鼻内窥镜检查再次发现脑脊液渗漏。虽然脑脊液细菌培养阴性，但临床诊断为细菌性脑膜炎。为了鉴定病原菌，我们对细菌16S rRNA基因测序进行了克隆文库分析。从CSF样本中提取DNA后，使用通用引物扩增16S rRNA基因，如前所述。2 PCR产物按照说明书使用TOPO TA克隆试剂盒（Invitrogen, Carlsbad， CA）进行克隆，随机选择96个菌落进行测序分析。牙周病（50%）在该方法中被发现最多（表，补充数字内容1，http://links）。lww。com/INF/E886)。开始使用头孢噻肟后症状迅速改善（图1）。患者在POD 14时接受外科手术修复脑脊液渗漏，在POD 21时停用头孢噻肟。使用POD 21采集的脑脊液样本进行16S rRNA基因分析时，未检测到牙周病沙门氏菌（图1；表，补充数字内容1，http://links）。lww。com/INF/E886)。修复脑脊液渗漏后，脑脊液鼻漏和脑膜炎均未复发。
A previously healthy 6-year-old boy underwent an endoscopic endonasal transsphenoidal surgery (ETSS) for craniopharyngioma. The patient temporarily had cerebrospinal fluid (CSF) rhinorrhea until postoperative day (POD) 2 and received prophylactic administration of cefotaxime until POD 3. On POD 6, he had fever, vomiting, and headache (Fig. 1). Peripheral white blood cell and neutrophil counts and serum C-reactive protein level on POD 8 were 14.8× 109/L, 11.7× 109/L, and 83.4 mg/L, respectively. CSF analysis showed pleocytosis (2,294/mL) with 98.3% of polynuclear cells. CSF leakage was detected again by nasal endoscopy. Although CSF bacterial culture was negative, we clinically diagnosed the patient as bacterial meningitis. To identify the causative bacteria, we performed a clone library analysis of the bacterial 16S rRNA gene sequencing. After the extraction of the DNA from the CSF sample, the 16S rRNA gene was amplified using universal primers as previously described. 2 The PCR products were cloned with a TOPO TA cloning kit (Invitrogen, Carlsbad, CA) according to the manufacturer’s instructions, and 96 colonies were randomly selected for sequencing analysis.S. periodonticum (50%) was the most predominantly identified in the method (Table, Supplemental Digital Content 1, http://links. lww. com/INF/E886). His symptoms rapidly improved after starting cefotaxime (Fig. 1). The patients underwent a surgical procedure to repair CSF leakage on POD 14 and cefotaxime was stopped on POD 21. S. periodonticum was undetected when the analysis of the 16S rRNA gene was performed using the CSF sample collected on POD 21 (Fig. 1; Table, Supplemental Digital Content 1, http://links. lww. com/INF/E886). Neither CSF rhinorrhea nor meningitis have recurred after repairing CSF leakage.