儿童产单核细胞李斯特菌脑膜炎2例并文献复习

Listeria monocytogenes Men Ingitis in Two Immunocompetent Children and a Review of the Literature

目的:总结2例免疫功能正常儿童产单核细胞李斯特菌(Lm)脑膜炎的临床特点及抗生素治疗效果,提高对该疾病的认识。方法:回顾性分析2018年5月至2020年5月山东大学附属威海市立医院儿科收治的2例免疫功能正常的儿童产单核细胞李斯特菌脑膜炎的临床特点及治疗经过,并进行相关文献复习,对比分析国内儿童Lm脑膜炎病例报道中误诊情况、抗生素使用及相关并发症情况。结果:患儿均有发热、胃肠道等症状,脑脊液检查为典型化脓性脑膜炎表现,误诊及漏诊患儿有11例,7例患儿出现并发症;治疗上对头孢类药物不敏感,青霉素类仍作为首选药,美罗培南、万古霉素、利奈唑胺亦可作为临床选择用药。结论:对于有胃肠道症状的脑膜炎患儿,经验性抗生素治疗无效时,需警惕Lm脑膜炎,减少误诊及漏诊率,及时开始能覆盖李斯特菌的抗生素治疗,降低死亡率。

Objective: To summarize the clinical characteristics and treatment outcome of 2 cases of Listeria monocytogenes (Lm) meningitis in immunocompetent children so as to improve clinician’s awareness of the disease. Methods: The clinical features and treatment of Lm meningitis in children admitted to the Pediatrics Department of Weihai Municipal Hospital affiliated to Shandong University from May 2018 to May 2020 were analyzed retrospectively. The study summarized related literatures, and compared selection of misdiagnosis, antibiotic use and related complications in children with Lm meningitis reported in cases. Results: All patients had typical purulent meningitis syndromes including fever, gastrointestinal tract, CSF and other symptoms;11 cases of misdiagnosis and missed diagnosis, and 7 cases had complications. Penicillins is currently the first choice of treatment, while meropenem, vancomycin and Linezolid could be administered as alternative drugs for Lm meningitis. Conclusions: For children with meningitis, when the empirical antibiotics treatment failed to be effective, the possibility of Lm meningitis should be considered, and ant-ibiotics that can effectively cover Lm should be adjusted in time.