星座链球菌引发脑脓肿1例

A case of brain abscess caused by Streptococcus constellatus

本文报道1例星座链球菌感染引发脑脓肿的病例。患者,男,54岁,视物成双19天,根据磁共振成像检查结果,不排除结核感染形成的结核球,予以抗结核治疗。同时对脑脊液进行宏基因组测序,结果提示直肠弯曲菌、福赛斯坦纳菌为主要致病菌。追问病史,患者有牙周病,近期左侧上颌疼痛明显。查阅文献有直肠弯曲菌引起颅内脓肿的报道,遂停用抗结核治疗,改用莫西沙星抗菌治疗。患者头痛不适加重,再次复查磁共振成像,提示病灶逐步扩大,病情变化较快,急诊行小脑占位性病变清除术,术中明确为脑脓肿;脑脓肿组织培养提示为星座链球菌。根据药敏给予利奈唑胺抗感染治疗,经综合治疗,患者病情平稳出院。本病例提示,星座链球菌作为一种口腔颌面部的常见感染菌,有可能引发脑脓肿,应引起临床工作者的注意。

This paper reports a case of brain abscess caused by Streptococcus constellatus.The patient,a 54-years-old male with double vision for 19 days,was treated with anti-tuberculous therapy based on nuclear magnetic resonance imaging(MRI)findings that did not exclude the formation of tuberculosis balls from tuberculosis infection.Metagenomic sequencing of the cerebrospinal fluid was also performed,and the results showed that Campylobacter recti and Fosetylastanella were the main causative organisms.On follow-up history,the patient had periodontal disease and recent significant left-sided maxillary pain.After reviewing the literature,there were reports of intracranial abscesses caused by Campylobacter recti,so anti-tuberculosis treatment was stopped and moxifloxacin antibacterial therapy was used instead.The patient's headache and discomfort worsened,and the MRI was repeated again,suggesting gradual expansion of the lesion and rapid change of the condition,and the cerebellar occupying lesion was removed urgently.Brain abscess with tissue culture resulted of Streptococcus constellatus.The patient was discharged from the hospital in stable condition after comprehensive treatment with linezolid anti-infective therapy according to drug sensitivity.