成人中枢神经系统李斯特菌感染患者的临床特征

Clinical features of adult patients with central nervous system Listeria monocytogenes infection

目的分析成人中枢神经系统李斯特菌感染的临床特点、治疗和转归,提高对中枢神经系统李斯特菌病的认识。方法回顾性分析北京协和医院1999年至2018年收治的成人中枢神经系统李斯特菌病患者的临床特征。结果共纳入34例成人中枢神经系统李斯特菌感染患者,女性占68%,平均年龄为(43±15)岁;32例(94%)患者有基础疾病;临床表现主要为发热(100%),意识改变(71%);实验室检查发现外周血白细胞和中性粒细胞计数均升高,淋巴细胞计数减少;C反应蛋白升高(85%);9例(26%)患者临床转归不佳,2例死亡,7例病重转院/出院。结论成人中枢神经系统李斯特菌病多累及原有免疫低下疾病患者,临床预后不良转归概率高,当免疫功能低下患者出现中枢神经系统感染症状时,应考虑到李斯特菌病,抗菌素经验用药应覆盖李斯特菌。

Objective To better understand the clinical characteristics of central nervous system of listeriosis.Methods The clinical data of adult patients with CNS listeriosis admitted to PUMCH from 1999 to 2018 were collected and reviewed.The clinical features were retrospectively analyzed.Results A total of 34 adult patients with CNS listeriosis were enrolled in this study.The average age of all patients was(43±15)years,from which female patients took 68%.Ninety four percent patients had at least one underlying disease.All patients had fever,and 71%of patients appeared altered consciousness.Peripheral blood leukocytes and neutrophils were significantly increased while the level of lymphocytes was decreased;85%of those patients had elevated C-reactive protein levels.Twenty-six percent had poor clinical outcomes.Conclusions Adult patients with CNS listeriosis are often associated with autoimmune diseases,and the clinical manifestation usually turns to be more serious.When patients have symptoms of central nervous system infection,the empirical medication should be covered listeria.