大颗粒淋巴细胞白血病并发鸟分枝杆菌脑膜炎一例并文献复习

doi:10.3969/j.issn.1000-6621.2021.06.019

摘要/Abstract

摘要：

非结核分枝杆菌中枢神经系统感染在我国较为少见。作者报道了1例鸟分枝杆菌脑膜炎患者。患者为女性,44岁,以“确诊T细胞大颗粒淋巴细胞白血病3年余,发热1d”住院,入院后行脑脊液检测,通过二代基因测序发现感染菌株为鸟分枝杆菌,从而采取了有效的治疗方法,最终鸟分枝杆菌脑膜炎获得治愈。作者通过复习相关文献,讨论了非结核分枝杆菌中枢神经系统感染的治疗方法,提醒临床医师警惕非结核分枝杆菌病的发生及其严重性,尽早明确病因并采取必要的干预措施。

关键词: 分枝杆菌,鸟, 中枢神经系统感染, 利奈唑胺, 综述文献(主题)

Abstract:

Non-tuberculous mycobacteria (NTM) central nervous system infection is rare in China. The author reported a case of Mycobacterium avium meningitis. The patient was a 44 years old female, admitted to hospital with “diagnosed as T-cell large granular lymphocyte leukemia for more than 3 years, having fever for 1 day”. After admission, cerebrospinal fluid was tested, and Mycobacterium avium was found with cerebrospinal fluid next generation sequencing, then patient was cured with effective treatment for Mycobacterium avium meningitis. By reviewing relevant literature, the author discusses about the treatment of NTM central nervous system infection, reminds clinicians to be alert to the occurrence and severity of NTM disease, to identify the causes as soon as possible and to take necessary intervention measures.

Key words: Mycobacterium avium, Central nervous system infections, Linezolid, Review literature as topic

洪飘如, 蒋慧芳, 陶叠宏, 苏传勇, 郭淑萍, 吴海英, 蒋玉霞, 叶萤燕. 大颗粒淋巴细胞白血病并发鸟分枝杆菌脑膜炎一例并文献复习[J]. 中国防痨杂志, 2021, 43(6): 631-635. doi: 10.3969/j.issn.1000-6621.2021.06.019

HONG Piao-ru, JIANG Hui-fang, TAO Die-hong, SU Chuan-yong, GUO Shu-ping, WU Hai-ying, JIANG Yu-xia, YE Ying-yan. A case of T-cell large granular lymphocyte leukemia complicated with Mycobacterium avium meningitis together with literature review[J]. Chinese Journal of Antituberculosis, 2021, 43(6): 631-635. doi: 10.3969/j.issn.1000-6621.2021.06.019

图/表 1

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参考文献 30

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例号及文献编号	年龄 (岁)	性别	临床症状	基础疾病	诊断方法	治疗方法	药品使用时间	预后
例1^[7]	48	男	发热3个月,双下肢无力1周	艾滋病	脑脊液培养结果为非结核分枝杆菌	异烟肼、利福平、乙胺丁醇和吡嗪酰胺	12d	死亡
例2^[7]	27	男	干咳和发热症状达6个月,并出现进行性呼吸困难达10d	艾滋病	脑脊液培养结果为非结核分枝杆菌	利福平、乙胺丁醇、阿米卡星、阿奇霉素和莫西沙星	73d	死亡
例3^[8]	24	男	头痛加剧,意识混乱,体质量减轻数月	后颅窝肿瘤病史	脑脊液培养显示抗酸杆菌阳性,推测为非结核分枝杆菌	阿奇霉素、阿米卡星和头孢西丁	32d	死亡
例4^[9]	14	女	头痛和抽搐2个月	后颅窝神经胶质瘤伴双侧心室扩张	脑脊液染色可见抗酸杆菌();GeneXpert MTB/RIF阴性。鉴定结果为福特分枝杆菌	利奈唑胺、氧氟沙星、氯法齐明、克拉霉素	3个月	好转
例5^[10]	13	女	持续发热数月	脊柱裂	脑脊液中分离出福特分枝杆菌	阿米卡星(42d)、甲氧苄氨嘧啶-磺胺甲恶唑	7.5个月	好转
例6^[11]	13	女	发热、头痛、呕吐	急性B淋巴细胞白血病	脑脊液细菌培养结果为非结核分枝杆菌	异烟肼、利福平、吡嗪酰胺、莫西沙星	18个月	治愈
本例	46	女	畏寒发热	T细胞大颗粒淋巴细胞白血病	脑脊液二代基因测序结果为鸟分枝杆菌	莫西沙星(4个月)、克拉霉素(4个月)、利奈唑胺	11个月	治愈