神经损伤与功能重建2026，Vol.21Issue(4)：194-198,221,6.DOI:10.16780/j.cnki.sjssgncj.20260256
成人非围产期中枢神经系统单核细胞增生李斯特菌感染的临床特征与治疗
Clinical Characteristics and Treatment of Adult Non-perinatal Listeria monocytogenes Infection of the Central Nervous System
陈彬 1赵莹莹 1乔杉杉 1李尧 1王淑辉 1许春伶1
作者信息
- 1. 首都医科大学附属北京友谊医院神经内科 北京 100050
- 折叠
摘要
Abstract
Objective:To investigate the clinical features,diagnosis,treatment,and prognosis of central nervous system(CNS)infections caused by Listeria monocytogenes(LM)in non-perinatal adults.Methods:A retrospective analysis was conducted on 6 cases of non-perinatal CNS-LM infection in adults at our hospital,combined with a review of the literature.Results:Among the 6 patients,3 were male and 3 female,with a median age of 56.5 years(range:43-70 years).All patients presented with high fever(＞39℃).Neck stiffness was observed in 5 cases,and 4 of them exhibited the classic triad of fever,impaired consciousness,and neck stiffness.Five patients had focal neurological deficits,and seizures occurred in 3.Cerebrospinal fluid(CSF)metagenomic next-generation sequencing(mNGS)was performed in 5 patients,and LM-specific sequences were detected in all.Blood culture and CSF culture were positive in 3 cases each.Neuroimaging revealed meningeal enhancement in 2 cases,rhombencephalitis in 1,hydrocephalus in 2,and concomitant lumbosacral meningeal and nerve root enhancement in 1.The median time from symptom onset to diagnosis was 12.5 days(range:4-63 days).After diagnosis,3 patients received first-line therapy with ampicillin(or penicillin)combined with gentamicin.Ultimately,1 patient was cured,3 showed clinical improvement but had residual neurological sequelae,and 2 died after withdrawal of treatment due to critical illness.A search of 317 previously reported cases of CNS-LM infection revealed that the most common manifestations were meningitis and meningoencephalitis.Among all cases,7％presented as brainstem encephalitis and less than 1％of cases involve concurrent myelitis and radiculitis.Conclusion:The clinical presentation of CNS-LM infection in adults is highly heterogeneous.For patients presenting with brainstem symptoms or lumbosacral nerve root symptoms,the possibility of LM infection should be considered.CSF mNGS can significantly improve pathogen detection and is valuable for early diagnosis.Empirical antimicrobial therapy should cover LM.Early initiation of adequate,combination therapy with sensitive antibiotics for a sufficient duration may help improve patient prognosis.关键词
中枢神经系统/单核细胞增生李斯特菌/临床特征/宏基因组二代测序/治疗Key words
central nervous system/Listeria monocytogenes/clinical characteristics/metagenomic next-generation sequencing/treatment分类
医药卫生引用本文复制引用
陈彬,赵莹莹,乔杉杉,李尧,王淑辉,许春伶..成人非围产期中枢神经系统单核细胞增生李斯特菌感染的临床特征与治疗[J].神经损伤与功能重建,2026,21(4):194-198,221,6.
