非围产期成人单核细胞性李斯特菌感染者25例的临床特征分析

Clinical characteristics of 25 non-perinatal adult patients with Listeria monocytogenes infection

目的探讨非围产期成人单核细胞性李斯特菌(LM)感染者的临床特征。方法纳入2010年1月至2023年7月第四军医大学唐都医院收治的经病原学确诊的25例非围产期李斯特菌病患者,回顾性分析患者人口学资料、基础疾病、临床表现、实验室检查指标、头颅影像学表现、抗感染治疗方案、临床转归等特征。分别比较李斯特菌败血症组和李斯特菌性脑膜脑炎组、康复组和死亡组患者的临床特征。统计学分析采用独立样本t检验和曼-惠特尼U检验。结果25例患者年龄为(52.84±12.17)岁,男18例,女7例,主要临床表现为发热[23/25(92%)]、头痛[15/25(60%)]、意识障碍[12/25(48%)]、呕吐[8/25(32%)],13例(52%)患者存在基础疾病(包括血液系统疾病、自身免疫病、实体肿瘤、肝硬化等)。李斯特菌败血症组和李斯特菌性脑膜脑炎组在血常规、转氨酶、蛋白质水平、肾功能、电解质、血糖、炎症指标之间的差异均无统计学意义(均P>0.05)。死亡组血小板计数高于康复组,差异有统计学意义[(243.10±92.96)×10^(9)/L比(157.80±75.55)×10^(9)/L,t=2.45,P=0.022],但康复组和死亡组在生物化学、炎症指标之间的差异均无统计学意义(均P>0.05)。李斯特菌性脑膜脑炎患者头颅影像学检查表现为颅内感染、脑水肿/脑积水或脑疝。19例李斯特菌性脑膜脑炎患者的脑脊液压力[220.0(130.0,290.0)mmH_(2)O(1 mmH_(2)O=0.0098 kPa)]、脑脊液细胞总数[522.0(350.0,783.0)×10^(6)/L]、脑脊液白细胞数[356.0(266.0,668.0)×10^(6)/L]和脑脊液蛋白质定量[1817.0(822.5,6000.0)mg/L]均升高,15例患者脑脊液氯化物降低[(111.70±8.51)mmol/L],10例患者脑脊液葡萄糖水平降低[3.71(1.45,7.11)mmol/L]。血培养和脑脊液培养药物敏感试验结果示LM对氨苄西林均敏感,分别有1例、3例、3例患者对青霉素、美罗培南、复方磺胺甲噁唑耐药。17例康复患者中13例使用基于氨苄西林或青霉素等敏感抗菌药物的治疗方案。结论罹患基础疾病、免疫功能低下的患者出现高热、中枢神经系统感染等临床症状时,应警惕李斯特菌病可能,早期应用以氨苄西林为基础的治疗方案有利于患者临床康复。

ObjectiveTo investigate the clinical characteristics of non-perinatal adult patients with Listeria monocytogenes(LM)infection.MethodsTwenty-five non-perinatal adult patients who were etiologically confirmed as listeriosis in Tangdu Hospital,Fourth Military Medical University during January 2010 and July 2023 were enrolled in this study.The characteristics of demographic data,underlying diseases,clinical manifestations,laboratory indicators,cranial imaging examination,anti-microbial therapeutic schemes and clinical outcomes were retrospectively analyzed.The clinical characteristics were compared between patients with Listeria septicemia and Listerial meningoencephalitis,as well as between survival and death patients.Independent samples t test and Mann-Whitney U test were used for statistical analysis.ResultsThe age of enrolled patients was(52.84±12.17)years.Eighteen patients were male,and seven patients were female.The major clinical manifestations included fever(23/25(92%)),headache(15/25(60%)),disorder of consciousness(12/25(48%))and vomiting(8/25(32%)).Thirteen(52%)patients had underlying diseases(including hematological diseases,autoimmune disorders,solid neoplasms,and liver cirrhosis,etc).There were no significant differences in blood routine test,aminotransferase,protein levels,renal function,electrolyte,blood glucose,and inflammatory indicators between patients with Listeria septicemia and Listerial meningoencephalitis(all P>0.05).The platelet count in the death group was significantly higher than that in the recovery group((243.10±92.96)×10^(9)/L vs(157.80±75.55)×10^(9)/L,t=2.45,P=0.022).There were also no significant differences in blood biochemical index and inflammatory indicators between these two groups(all P>0.05).Cranial imaging examination of patients with Listerial meningoencephalitis manifested as intracranial infection,cerebral edema/hydrocephalus or cerebral hernia.All nineteen patients with Listerial meningoencephalitis had elevated cerebrospinal fluid(CSF)pressure(220.0(130.0,290.0)mmH_(2)O(1 mmH_(2)O=0.0098 kPa)),elevated CSF total cell count(522.0(350.0,783.0)×10^(6)/L),elevated CSF white blood cell count(356.0(266.0,668.0)×10^(6)/L),and CSF protein level(1817.0(822.5,6000.0)mg/L).Fifteen patients had reduced CSF chloride level((111.70±8.51)mmol/L).Ten patients had decreased CSF glucose level(3.71(1.45,7.11)mmol/L).The drug sensitivity results of blood and CSF cultures revealed that LM was sensitive to ampicillin.One case was resistance to penicillin,three cases were resistance to meropenem,while three cases were resistance to trimethoprim-sulfonamide.Thirteen cases out of seventeen recovery patients were administered with ampicillin or penicillin-based therapy.ConclusionsWhen patients with underlying diseases or immune dysfunction suffered with clinical symptoms such as high fever,central nervous system infection,they should be alert to the possibility of listeriosis.Early administration of ampicillin-based therapeutic strategy is beneficial for clinical recovery of the patients.