出芽短梗霉致脑膜炎1例及文献分析

One case of meningitis infection caused by Aureobasidium pullulans and literature review

目的了解出芽短梗霉的分类、形态学特征、可能致病机制及其导致脑膜炎的临床特征、治疗方法,提高对出芽短梗霉导致颅内感染的认识。方法分析1例诊断为脑膜炎的病例,该患者持续低热1月余,脑脊液病原微生物基因检测报告示出芽短梗霉检出序列数最高(60),通过检索国内外文献,采用伏立康唑抗真菌治疗,观察临床疗效。检索国内外该真菌感染的病例,国外文献检索到该真菌导致脑膜炎病例2篇,国内文献检索到该真菌导致皮肤感染1篇、血流感染1篇。结果本病例患者应用伏立康唑治疗3月余,患者再无低热症状,脑脊液常规无明显异常。回顾国内外病例,国外病例显示,两性霉素B、伏立康唑能有效改善脑膜炎患者症状,2例国内报道显示,伊曲康唑对皮肤感染、氟康唑对血流感染有效。结论对于出芽短梗霉导致脑膜炎的患者,应用伏立康唑治疗可能有效。

Objective To preliminarily understand the classification,morphological characteristics,possible pathogenic mechanism of Aureobacidium pullulans as well as the clinical characteristics and therapeutic drugs of meningitis caused by Aureobasidium pullulans,and improve the awareness of Aureobasidium pullulans-induced meningitis.Methods One case of meningitis was analyzed.The patient had a sustained low fever for more than one month,and the genetic test report of pathogenic microorganisms in the cerebrospinal fluid showed that Aureobasidium pullulans had the highest detected sequence(60).After searching domestic and foreign literature,voriconazole was used for antifungal therapy and the clinical efficacy was observed.At the same time,the domestic and foreign cases of this fungus were reviewed,and 2 cases of meningitis caused by this fungus were retrieved abroad,and 1 case of skin infection and 1 case of bloodstream infection were retrieved in China.Results After using voriconazole for more than 3 months,the patient no longer had symptoms of low fever,and the result of routine cerebrospinal fluid test improved significantly.Review of foreign cases showed that amphotericin B and voriconazole could effectively improve the symptoms of meningitis,and 2 domestic reports showed that itraconazole was effective for skin infection and fluconazole was effective for bloodstream infection.Conclusion Voriconazole may be effective in the treatment of meningitis caused by Aureobasidium pullulans.