既往健康青少年由双歧杆菌属所致脑脓肿：一例病例报告

文献信息

中文摘要

背景： 儿童脑脓肿虽不常见，但属于严重疾病。双歧杆菌属通常被视为口腔、胃肠道和女性生殖道的共生菌，罕见于侵袭性感染。我们报告一例既往健康的11岁男性，因慢性左侧鼻窦炎伴筛骨侵蚀直接蔓延而继发双歧杆菌属所致多发性脑脓肿。
方法： 神经影像学显示左侧额叶脓肿，伴有明显病灶周围水肿、环形强化和中线移位，同时左侧上颌窦、筛窦和额窦浑浊。脑脓肿抽吸物和鼻窦样本中均仅分离出双歧杆菌属。
结果： 患者接受了脓肿钻孔抽吸和同期内镜鼻窦手术，随后接受六周静脉结晶青霉素G治疗。患者获得完全临床康复，无神经系统后遗症，随访MRI显示稳定的残留改变。
结论： 据我们所知，这是首例详细报道的既往健康儿童患者由双歧杆菌属所致脑脓肿。本病例凸显了这种通常为共生性的微生物可通过鼻窦直接蔓延引起严重中枢神经系统感染的潜力。

英文摘要

Brain abscesses in children are uncommon but serious conditions. Bifidobacterium species, typically considered commensal organisms of the oral cavity, gastrointestinal tract, and female genital tract, are rarely implicated in invasive infections. We present a case of multiple brain abscesses caused by Bifidobacterium spp. in a previously healthy 11-year-old male, secondary to contiguous spread from chronic left-sided paranasal sinusitis with ethmoid bone erosion. Neuroimaging demonstrated left frontal abscesses with marked perilesional edema, ring enhancement and midline shift, together with opacification of the left maxillary, ethmoid and frontal sinuses. Bifidobacterium spp. was the only organism isolated from both the brain abscess aspirate and the sinus samples. The patient was treated with burr-hole aspiration of the abscesses and same-session endoscopic sinus surgery, followed by six weeks of intravenous crystalline penicillin G. He achieved full clinical recovery without neurological sequelae, with stable residual changes on follow-up MRI. To our knowledge, this is the first detailed case report of a brain abscess caused by Bifidobacterium spp. in a previously healthy pediatric patient. This case highlights the potential of this typically commensal organism to cause serious central nervous system infection via contiguous spread from the paranasal sinuses.