慢生黄分枝杆菌所致颅内感染1例分析并文献复习

Intracranial infection due to Mycobacterium lentiflavum:a case report and literature review

目的分析慢生黄分枝杆菌所致颅内感染患者的临床特征。方法分析天津市海河医院2023年5月收治的1例慢生黄分枝杆菌所致颅内感染患者的临床资料,同时查阅并复习文献,仅获得该病相关英文文献报道1篇。分析并总结本例及文献中患者的临床特点。结果文献报道的1例慢生黄分枝杆菌所致脑膜脑炎患者加上本例患者,共计2例,均为女性,分别为42岁、55岁,均表现为慢性病程,无发热,均为进行性加重的头痛、认知损害,亦可表现为精神行为异常、肢体无力、癫痫发作,早期可仅有颅内压升高,脑脊液化验阴性,随着疾病进展出现脑脊液细胞数、蛋白升高,葡萄糖、氯化物等均正常。通过活组织检查获取病变脑组织行聚合酶链反应或二代测序检查而确诊。患者经抗生素治疗效果好,治疗疗程长,预后良好。结论慢生黄分枝杆菌所致颅内感染十分罕见,为慢性病程,诊断十分困难,但治疗效果显著,预后良好。

Objective To analyze the clinical characteristics of intracranial infection caused by Mycobacterium lentiflavum.Methods The clinical data of a patient with intracranial infection caused by Mycobacterium lentiflavum admitted to Tianjin Haihe Hospital in May 2023 were collected.Meanwhile relevant literatures in databases were searched.Only 1 English literature(1 patient)was obtained.The clinical characteristics of this patient and the case reported in the literature were analyzed and summarized.Results Totally 2 patients,including this case,and the patient with meningoencephalitis caused by Mycobacterium lentiflavum reported in the literature,both are females,42 and 55 years old respectively,both manifested a chronic course,without fever,and presented progressive headache and cognitive impairment.Clinical manifestations also included abnormal mental behavior,limb weakness,and seizure.At the early stage,only intracranial pressure increased,and cerebrospinal fluid tests were negative.As the disease aggravated,there was an elevation of cerebrospinal fluid cells and protein,with normal levels of glucose and chloride.Using brain tissue obtained by biopsy for polymerase chain reaction or next-generation sequencing examination,the pathogenic microorganism was confirmed,which made accurate diagnosis possible.Antibiotic treatment had good efficacy,with a long treatment course and a good prognosis.Conclusions Central nervous system infection caused by Mycobacterium lentiflavum is very rare,and a chronic disease course makes diagnosis very difficult.The treatment effect is significant,and the prognosis is excellent.