猪链球菌脑膜炎并发交通性脑积水：非神经外科治疗实现临床与影像学完全缓解——一例病例报告
Streptococcus suis meningitis complicated with communicating hydrocephalus: complete clinical and radiological resolution with non-neurosurgical management-A case report.
文献信息
| PMID | 42729271 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Mei Qi |
| 作者单位 | Xiaolan Clinical Institute of Shantou University Medical College, Zhongshan, Guangdong, China. |
| 期刊 | Frontiers in medicine |
| SCI 分区 | Q1 |
| IF | 3.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 猪链球菌（S. suis）脑膜炎是一种严重的人畜共患中枢神经系统感染，永久性感音神经性听力损失是其最常见的长期后遗症。脑积水是猪链球菌脑膜炎极为罕见且认识不足的并发症，且尚无正式记录的猪链球菌脑膜炎继发交通性脑积水经非神经外科治疗成功管理的病例。
病例介绍： 一名52岁男性因进行性头晕和步态不稳8天就诊。增强磁共振成像（MRI）证实交通性脑积水伴弥漫性软脑膜强化，无脑室梗阻。脑脊液（CSF）培养持续阴性，而宏基因组下一代测序（mNGS）在48小时内鉴定出猪链球菌，相对丰度为92.60%。指南推荐的目标性抗菌治疗联合短程辅助地塞米松实现了临床与影像学完全缓解，无需神经外科干预。患者在10个月随访时仍无症状，双侧听力完好。
结论： 据我们所知，这是首例报告的猪链球菌脑膜炎相关交通性脑积水在未行神经外科手术的情况下成功管理的病例。通过增强MRI准确进行脑积水分型以及通过mNGS快速鉴定病原体，可能有助于为精心选择的患者进行非神经外科管理的潜在可能性提供临床决策依据。
英文摘要
BACKGROUND: Streptococcus suis (S. suis) meningitis is a severe zoonotic central nervous system infection, with permanent sensorineural hearing loss as its most common long-term sequela. Hydrocephalus is an extremely rare and underrecognized complication of S. suis meningitis, and no case of communicating hydrocephalus secondary to S. suis meningitis managed successfully with non-neurosurgical therapy has been formally documented.
CASE PRESENTATION: A 52-year-old man presented with 8 days of progressive dizziness and gait imbalance. Contrast-enhanced magnetic resonance imaging (MRI) confirmed communicating hydrocephalus with diffuse leptomeningeal enhancement and no ventricular obstruction. Cerebrospinal fluid (CSF) cultures remained persistently negative, while metagenomic next-generation sequencing (mNGS) identified S. suis within 48 h with a relative abundance of 92.60%. Guideline-recommended targeted antimicrobial therapy combined with short-course adjunctive dexamethasone achieved complete clinical and radiological resolution without neurosurgical intervention. The patient remained asymptomatic with intact bilateral hearing at the 10-month follow-up.
CONCLUSION: To our knowledge, this is the first reported case of S. suis meningitis-associated communicating hydrocephalus successfully managed without neurosurgery. Accurate hydrocephalus subtyping via contrast-enhanced MRI and rapid pathogen identification via mNGS may help inform clinical decision-making regarding the potential for non-neurosurgical management in carefully selected patients.