重症中枢神经系统李斯特菌感染2例(附文献复习)

Severe neurolisteriosis:case report and literature review

目的：探讨重症中枢神经系统李斯特菌感染的病因、发病机制、临床表现、影像学特点、治疗及预后。方法：回顾中日友好医院神经内科2014年10月~2015年6月期间收治的2例重症中枢李斯特菌感染患者的临床资料,分析其临床特点、实验室检查、治疗及预后,并复习相关文献。结果：神经系统李斯特菌感染主要累及免疫抑制的患者,但其中脑干脑炎的患者常为没有易感因素的年轻人。中枢神经系统李斯特菌感染常引起脑膜炎、脑炎或者脑干脑炎。影像学检查异常率不高,主要表现为脑干脑炎、脑室扩张等。目前没有中枢神经系统李斯特菌感染的最佳治疗方案和治疗时限,早期联合使用抗菌素被认为可能有较好的效果。结论：重症中枢神经系统李斯特菌感染病情进展迅速,死亡率高,需要尽早诊治,从而改善预后。

Objective：To review the cause,pathogenesis,clinical features,imaging characteristics,treatment and prognosis of the severe neurolisteriosis.Methods：The clinical characteristics,laboratory findings,treatment and prognosis of 2 patients with severe neurolisteriosis,admitted to our hospital from October 2014 to June 2015,were reported.Literatures of neurolisteriosis were reviewed.Results：Neurolisteriosis was mainly diagnosed in patients with immunosuppression.Those patients presented as rhombencephalitis were usually diagnosed in young individuals without any predisposing factors.Neurolisteriosis can present as meningitis,encephalitis,or rhombencephalitis.The abnormalities in imaging examination were rhombencephalitis,non-specific dilatation of brain ventricle,however the majority did not have abnormality in imaging examination.Early combination of antibiotics could be a choice,but the optimal therapeutic regimen of neurolisteriosis had not been definitively defined.Conclusion：The neurolisteriosis is a fatal disease,the diagnosis and treatment should be as soon as possible to improve the prognosis.