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首页> 外文期刊>Medecine et maladies infectieuses >Meningitis due to Fusobacterium nucleatum after a kart crash
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Meningitis due to Fusobacterium nucleatum after a kart crash

机译：卡丁车撞车后因核梭状芽胞杆菌引起的脑膜炎

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摘要

Fusobacterium nucleatum is an anaerobic Gram-negative bacillus mainly involved in periodontal diseases. This bacterium has been associated with several systemic infections such as spondylodiscitis [1], endocarditis [2], brain abscesses [3], etc. but as far as we know, never to primitive meningitis. Meningitis had been reported in 2 patients but as a consequence of a brain abscess in one case [2] and of an ENT infection with spheno-maxillary sinusitis and cavernous sinus thrombosis in the other case [4]. We report a case of primary meningitis due to F. nucleatum.A 60-year-old male patient presenting with type-2 diabetes mellitus was hospitalized for lumbar pain persisting for the 2 previous weeks. He had been involved in a kart race accident. Lumbar pain had appeared following the crash. One week later, he had presented with fever and chills. He was hospitalized 10 days later, for pain and fever (38.5 °C). He also presented with ideomotor slowing apraxia. Physical examination revealed a slightly stiff neck, and abdominal distension and bloating. The brain CT scan was normal and the thoracic CT scan revealed a burst fracture of the 1st lumbar vertebra with bone retropulsion (mainly on the right side of the vertebra). Biological examinations documented an inflammatory syndrome (CRP: 243 mg/L) and elevated white blood cell count (17,440 leucocytes/mL with 90% polymorphonuclear cells). A lumbar puncture was performed because of the fever and stiff neck. The cerebrospinal fluid (CSF) examination revealed meningitis with a very high white blood cell count (21,300/mm3) mostly polymorphonuclear cells (92%), elevated protein level (1.21 g/L), and low glucose level (0.53 g/L) compared to the patient's glycemia (30% of the glycemia). No bacterium was isolated, either on direct examination or after culture. A combination of cefotaxime and fosfomycine IV was initiated targeting common bacteria including Staphylococcus spp. because of a suspected hematoma due to the spinal fracture. F. nucleatum was identified on the 5 blood cultures and metronidazole was added to the treatment. Another lumbar puncture was performed to isolate F. nucleatum in the CSF but after 2 days of metronidazole intake. The laboratory results were improved, with a dramatic decrease of the white blood cell count (220/mm3) and protein levels (0.68 g/L); but the bacterium was not detected. Magnetic resonance imaging revealed an abscess (3 cm in diameter) in the right psoas, next to the fractured vertebra, extending to the dura without any epidural extension. Metronidazole alone was maintained and the outcome was satisfactory. Metronidazole was continued for 3 weeks. The dental exam was normal and a colonoscopy revealed 2 polyps without any sign of cancer. Several weeks after the end of antibiotic treatment, the patient was in good health without any pain, and no symptoms of meningitis.
机译：核梭菌是一种厌氧性革兰氏阴性杆菌，主要参与牙周疾病。该细菌与几种全身感染有关，例如脊椎盘炎[1]，心内膜炎[2]，脑脓肿[3]等，但据我们所知，从未与原始脑膜炎有关。据报道有2例脑膜炎，但其中1例是由于脑脓肿[2]，另一例是由于ENT感染有上颌窦鼻窦炎和海绵窦血栓形成[4]。我们报告了一例由于核镰刀菌引起的原发性脑膜炎。一名2岁糖尿病患者现年60岁，因腰痛持续住院治疗前2周。他曾参加过卡丁车比赛事故。坠机后出现腰痛。一个星期后，他表现出发烧和发冷。 10天后因疼痛和发烧（38.5°C）住院。他还表现出意识运动减慢性失用症。体格检查发现颈部略有僵硬，腹胀和腹胀。脑部CT扫描正常，胸部CT扫描显示第一腰椎爆裂性骨折并伴有骨反冲（主要在椎骨的右侧）。生物学检查证明有炎症综合症（CRP：243 mg / L）和白细胞计数升高（17,440白细胞/ mL，多形核细胞占90％）。由于发烧和脖子僵硬而进行了腰穿。脑脊液（CSF）检查显示脑膜炎的白细胞计数很高（21,300 / mm3），多数为多形核细胞（92％），蛋白水平升高（1.21 g / L）和葡萄糖水平低（0.53 g / L）与患者的血糖（血糖的30％）相比。在直接检查或培养后均未分离出细菌。头孢噻肟和磷磷霉素IV的组合开始针对包括葡萄球菌属的常见细菌。因为怀疑是由于脊柱骨折引起的血肿。在5种血液培养物中鉴定出了F. nucleatum，并向其中加入了甲硝唑。再次进行腰椎穿刺以分离CSF中的F. nucleatum，但摄入甲硝唑2天后。实验室结果得到改善，白细胞计数（220 / mm3）和蛋白质水平（0.68 g / L）显着降低。但未检测到细菌。磁共振成像显示右侧腰大肌中有一个脓肿（直径3厘米），紧挨着破裂的椎骨，一直延伸到硬脑膜，没有硬膜外延伸。单独使用甲硝唑治疗，结果令人满意。甲硝唑持续3周。牙科检查正常，结肠镜检查显示有2处息肉，没有任何癌症迹象。抗生素治疗结束几周后，患者身体健康，没有任何疼痛，也没有脑膜炎的症状。

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