单核细胞增生李斯特菌感染的临床特征

Clinical characteristics of Listeria monocytogenes infection

摘要:

目的 分析单核细胞增生李斯特菌感染患者的临床特征及治疗情况。方法 回顾性收集2016年1月-2018年12月某院单核细胞增生李斯特菌感染患者的临床资料，分析患者的临床特征、实验室检查、抗菌药物使用方案及预后等。结果 15例单核细胞增生李斯特菌感染患者，其中非妊娠成年人大多为65岁以上且有基础疾病的老年人；14例败血症患者（其中1例合并化脓性脑膜炎），1例化脓性脑膜炎患者。败血症成年患者均有发热，新生儿仅1例有发热；2例化脓性脑膜炎患者除发热外均有头痛、呕吐等神经系统症状。15例患者中大部分患者白细胞、C反应蛋白（CRP）、降钙素原（PCT）均升高，2例化脓性脑膜炎患者脑脊液检查明显异常。治疗上予以单用青霉素或美罗培南，或者两种药物联合使用，14例患者好转，1例患者病情加重。结论 单核细胞增生李斯特菌主要引起新生儿、孕妇、老年人、免疫力低下人群感染，感染类型常见血流感染或化脓性脑膜炎，青霉素、氨苄西林、美罗培南和复方磺胺甲口恶唑可用来经验性治疗单核细胞增生李斯特菌感染。

Abstract:

Objective To analyze the clinical characteristics and therapy of Listeria monocytogenes (L. monocytogenes) infection. Methods Clinical data of patients with L. monocytogenes infection in a hospital from January 2016 to December 2018 were collected retrospectively, clinical characteristics, laboratory test, antimicrobial use program and prognosis of patients were analyzed. Results A total of 15 patients with L. monocytogenes infection were collected, most of the non-pregnant adults were over 65 years old and with underlying diseases; 14 patients were with septicemia (including 1 case combined with suppurative meningitis), and 1 case with suppurative meningitis. All the adult patients with septicemia had fever, and only 1 neonate had fever; 2 patients with suppurative meningitis had headache, vomiting and other neurological symptoms besides fever. The levels of leukocyte, C-reactive protein and procalcitonin increased in most of the 15 patients, cerebrospinal fluid examination of 2 patients with suppurative meningitis was obviously abnormal. 14 patients improved after receiving penicillin or meropenem therapy alone, or combined use of two drugs, 1 patient was worsened. Conclusion L. monocytogenes mainly causes bloodstream infection or suppurative meningitis in neonates, pregnant women, the elderly, and immunocompromised person, penicillin, ampicillin, meropenem and compound sulfamethoxazole can be used for empirical therapy for L. monocytogenes infection.