病例报告：猪链球菌相关脑膜脑炎伴重度双侧迷路性耳聋及术中耳蜗纤维化，经人工耳蜗植入治疗。
Case Report: Streptococcus suis-associated meningoencephalitis with profound bilateral labyrinthine deafness and intra-operative cochlear fibrosis treated by cochlear implantation.
文献信息
| PMID | 42856881 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Lingping Ding |
| 作者单位 | Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 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： 猪链球菌是一种常见的人畜共患病原体，通常引起单一微生物性脑膜炎。隐匿性血流检出肺炎克雷伯菌，同时证实中枢神经系统猪链球菌感染，随后出现不可逆的耳蜗纤维化改变并需要人工耳蜗植入，似乎极为罕见。方法：我们报告一名52岁男性，有长期大量饮酒史和职业性猪接触史，他发生了严重脓毒症、由猪链球菌引起的复发性化脓性脑膜脑炎以及永久性双侧迷路相关性耳聋。结果：联合血液和脑脊液（CSF）宏基因组下一代测序（mNGS）鉴定出疑似额外的肺炎克雷伯菌血流感染，尽管在CSF中未检测到肺炎克雷伯菌。多模式抗微生物、抗炎和免疫调节治疗清除了颅内感染，但未能恢复听力。术前影像提示耳蜗纤维化改变；尽管术中观察到大量耳蜗内纤维组织，左侧人工耳蜗植入实现了完全电极插入，并伴有稳定的术中神经反应。结论：本病例提出三个重要考虑：职业性猪接触加上慢性酒精中毒可能合理地促成疑似多种微生物脓毒症；在选定患者中，当复发性脑膜炎期间CSF检测仍为阴性时，外周血mNGS可能有助于识别隐匿性革兰阴性菌血症；耳蜗纤维化可能并不绝对排除技术上成功的人工耳蜗植入。
英文摘要
Streptococcus suis is a common zoonotic pathogen that usually causes monomicrobial meningitis. Occult bloodstream detection of Klebsiella pneumoniae, together with proven central-nervous-system S. suis infection, followed by irreversible cochlear fibrotic changes requiring cochlear implantation, appears exceptionally rare. We report a 52-year-old male with chronic heavy alcohol intake and occupational swine-exposure history who developed severe sepsis, recurrent suppurative meningoencephalitis caused by S. suis, and permanent bilateral labyrinthine-related deafness. Combined blood and cerebrospinal fluid (CSF) metagenomic next-generation sequencing (mNGS) identified suspected additional bloodstream infection by K. pneumoniae, although K. pneumoniae was not detected in CSF. Multimodal antimicrobial, anti-inflammatory, and immunomodulatory therapy cleared intracranial infection but failed to restore hearing. Preoperative imaging suggested cochlear fibrotic changes; left-sided cochlear implantation achieved full electrode insertion with stable intraoperative neural responses despite abundant intracochlear fibrous tissue observed intraoperatively. This case raises three important considerations: occupational swine exposure together with chronic alcoholism may plausibly contribute to suspected polymicrobial sepsis; in selected patients, peripheral-blood mNGS may help identify occult Gram-negative bacteremia when CSF assays remain negative during recurrent meningitis; and cochlear fibrosis may not absolutely preclude technically-successful cochlear implantation.