化膿性脳室炎を合併した細菌性髄膜炎における抗菌薬治療～自験例と症例報告の検討
症例は68歳男性．意識障害を主訴に救急搬送された．来院時のvital signs，血液所見，髄液所見から細菌性髄膜炎および敗血症性ショックと診断し，抗菌薬3剤によるempiric therapyを開始した．後日髄液から肺炎球菌が検出された．頭部MRIで化膿性脳室炎の所見がみられた．抗菌薬治療により髄液所見は改善したが意識障害は遷延し，経過中に肺炎を合併して死亡した．化膿性脳室炎の合併が細菌性髄膜炎に対する抗菌薬治療に影響を与えるかどうかは分かっていない．細菌性髄膜炎の自験例11例では化膿性脳室炎の有無に関わらず，臨床所見や髄液所見を参考に抗菌薬投与期間を決めている例が多かった．...
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| Published in | 臨床神経学 Vol. 59; no. 3; pp. 133 - 138 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2019
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001210 |
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| Abstract | 症例は68歳男性．意識障害を主訴に救急搬送された．来院時のvital signs，血液所見，髄液所見から細菌性髄膜炎および敗血症性ショックと診断し，抗菌薬3剤によるempiric therapyを開始した．後日髄液から肺炎球菌が検出された．頭部MRIで化膿性脳室炎の所見がみられた．抗菌薬治療により髄液所見は改善したが意識障害は遷延し，経過中に肺炎を合併して死亡した．化膿性脳室炎の合併が細菌性髄膜炎に対する抗菌薬治療に影響を与えるかどうかは分かっていない．細菌性髄膜炎の自験例11例では化膿性脳室炎の有無に関わらず，臨床所見や髄液所見を参考に抗菌薬投与期間を決めている例が多かった． |
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| AbstractList | 症例は68歳男性．意識障害を主訴に救急搬送された．来院時のvital signs，血液所見，髄液所見から細菌性髄膜炎および敗血症性ショックと診断し，抗菌薬3剤によるempiric therapyを開始した．後日髄液から肺炎球菌が検出された．頭部MRIで化膿性脳室炎の所見がみられた．抗菌薬治療により髄液所見は改善したが意識障害は遷延し，経過中に肺炎を合併して死亡した．化膿性脳室炎の合併が細菌性髄膜炎に対する抗菌薬治療に影響を与えるかどうかは分かっていない．細菌性髄膜炎の自験例11例では化膿性脳室炎の有無に関わらず，臨床所見や髄液所見を参考に抗菌薬投与期間を決めている例が多かった． |
| Author | 井口, 正寛 村上, 丈伸 伊藤, 英一 時村, 瞭 宇川, 義一 |
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| References | 13) McGill F, Heyderman RS, Panagiotou S, et al. Acute bacterial meningitis in adults. Lancet 2016;388:3036-3047. 29) Marinelli L, Trompetto C, Cocito L. Diffusion magnetic resonance imaging diagnostic relevance in pyogenic ventriculitis with an atypical presentation: a case report. BMC Res Notes 2014;7:149. 27) Vajramani GV, Akrawi H, Jones G, et al. Primary ventriculitis caused by Streptococcus intermedius. Br J Neurosurg 2007;21:293-296. 8) Breeze RE, McComb JG, Hyman S, et al. CSF production in acute ventriculitis. J Neurosurg 1989;70:619-622. 12) van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849-1859. 7) Kiyan S, Aksay E, Ersel M, et al. A rare diagnosis in ED: cerebral pyogenic ventriculitisdue to infective endocarditis. Am J Emerg Med 2007;25:120-122. 14) Lazzarini L, Toti M, Fabris P, et al. Clinical features of bacterial meningitis in Italy: a multicenter prospective observational study. J Chemother 2008;20:478-487. 15) 下畑享良，栁川香織，田中惠子ら．予後不良であった細菌性髄膜炎症例の臨床像の検討．臨床神経 2010;50:137-140. 18) Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol 2008;15:649-659. 23) 中原広明，小田智三，深尾絵里ら．脳室炎を併発し，治療に難渋した髄膜炎菌性髄膜炎の1例．臨床神経 2016;56:344-347. 19) 細菌性髄膜炎の診療ガイドライン2014作成委員会（日本神経学会，他監修）．細菌性髄膜炎診療ガイドライン2014．東京：南江堂；2014. 1) Fujikawa A, Tsuchiya K, Honya K, et al. Comparison of MRI sequences to detect ventriculitis. AJR Am J Roentgenol 2006;187:1048-1053. 9) Lummel N, Koch M, Klein M, et al. Spectrum and prevalence of pathological intracranial magnetic resonance imaging findings in acute bacterial meningitis. Clin Neuroradiol 2016;26:159-167. 17) Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267-1284. 16) Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015;9:CD004405. 24) Nakayasu H, Sawada H, Doi M, et al. Spontaneous haemophilus influenzae type B meningoventriculitis with intraventricular debris. Intern Med 2005;44:332-334. 22) Yanase T, Morii D, Kamio S, et al. The first report of human meningitis and pyogenic ventriculitis caused by Streptococcus suis: A case report. J Infect Chemother 2018;24:669-673. 2) Hazany S, Go JL, Law M. Magnetic resonance imaging of infectious meningitis and ventriculitis in adults. Top Magn Reson Imaging 2014;23:315-325. 6) Fukui MB, Williams RL, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol 2001;22:1510-1516. 11) O’Neill P. How long to treat bacterial meningitis. Lancet 1993;341:530. 5) Engelen-Lee JY, Brouwer MC, Aronica E, et al. Pneumococcal meningitis: clinical-pathological correlations (MeninGene-Path). Acta Neuropathol Commun 201622;4:26. 26) Jourani M, Duprez T, Roelants V, et al. Acute Bacterial Meningitis and Systemic Abscesses due to Streptococcus dysgalactiae subsp. equisimilis Infection. Case Rep Infect Dis 2017;2017:8645859. 30) van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849-1859. 20) Scheld WM. Rationale for optimal dosing of beta-lactam antibiotics in therapy for bacterial meningitis. Eur J Clin Microbiol 1984;3:579-591. 25) Gronthoud F, Hassan I, Newton P. Primary pyogenic ventriculitis caused by Neisseria meningitidis; case report and review of the literature. JMM Case Rep 2017;4:e005078. 10) Grandgirard D, Gäumann R, Coulibaly B, et al. The causative pathogen determines the inflammatory profile in cerebrospinal fluid and outcome in patients with bacterial meningitis. Mediators Inflamm 2013;2013:312476. 21) 畠山公大，金澤雅人，石原彩子ら．頭部MRIで特徴的な液面形成（fluid-fluid level）をみとめた化膿性脳室炎の2例．臨床神経 2014;54:732-737. 28) Lo WB, Mitra R, Cadwgan A, et al. Pyogenic ventriculitis and the ‘lodge sign’. Acta Neurochir 2016;158:1849-1850. 3) Woehrl B, Linn J, Lummel N, et al. Pneumococcal meningitis-associated pyogenic ventriculitis. J Infect 2015;70:311-314. 4) Amit A, Rafael C, Jake T. Current concepts and approach to ventriculitis. Infect Dis Clin Pract 2008;16:100-104. |
| References_xml | – reference: 8) Breeze RE, McComb JG, Hyman S, et al. CSF production in acute ventriculitis. J Neurosurg 1989;70:619-622. – reference: 20) Scheld WM. Rationale for optimal dosing of beta-lactam antibiotics in therapy for bacterial meningitis. Eur J Clin Microbiol 1984;3:579-591. – reference: 6) Fukui MB, Williams RL, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol 2001;22:1510-1516. – reference: 14) Lazzarini L, Toti M, Fabris P, et al. Clinical features of bacterial meningitis in Italy: a multicenter prospective observational study. J Chemother 2008;20:478-487. – reference: 24) Nakayasu H, Sawada H, Doi M, et al. Spontaneous haemophilus influenzae type B meningoventriculitis with intraventricular debris. Intern Med 2005;44:332-334. – reference: 18) Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol 2008;15:649-659. – reference: 9) Lummel N, Koch M, Klein M, et al. Spectrum and prevalence of pathological intracranial magnetic resonance imaging findings in acute bacterial meningitis. Clin Neuroradiol 2016;26:159-167. – reference: 25) Gronthoud F, Hassan I, Newton P. Primary pyogenic ventriculitis caused by Neisseria meningitidis; case report and review of the literature. JMM Case Rep 2017;4:e005078. – reference: 10) Grandgirard D, Gäumann R, Coulibaly B, et al. The causative pathogen determines the inflammatory profile in cerebrospinal fluid and outcome in patients with bacterial meningitis. Mediators Inflamm 2013;2013:312476. – reference: 12) van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849-1859. – reference: 7) Kiyan S, Aksay E, Ersel M, et al. A rare diagnosis in ED: cerebral pyogenic ventriculitisdue to infective endocarditis. Am J Emerg Med 2007;25:120-122. – reference: 27) Vajramani GV, Akrawi H, Jones G, et al. Primary ventriculitis caused by Streptococcus intermedius. Br J Neurosurg 2007;21:293-296. – reference: 2) Hazany S, Go JL, Law M. Magnetic resonance imaging of infectious meningitis and ventriculitis in adults. Top Magn Reson Imaging 2014;23:315-325. – reference: 11) O’Neill P. How long to treat bacterial meningitis. Lancet 1993;341:530. – reference: 13) McGill F, Heyderman RS, Panagiotou S, et al. Acute bacterial meningitis in adults. Lancet 2016;388:3036-3047. – reference: 1) Fujikawa A, Tsuchiya K, Honya K, et al. Comparison of MRI sequences to detect ventriculitis. AJR Am J Roentgenol 2006;187:1048-1053. – reference: 4) Amit A, Rafael C, Jake T. Current concepts and approach to ventriculitis. Infect Dis Clin Pract 2008;16:100-104. – reference: 21) 畠山公大，金澤雅人，石原彩子ら．頭部MRIで特徴的な液面形成（fluid-fluid level）をみとめた化膿性脳室炎の2例．臨床神経 2014;54:732-737. – reference: 30) van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004;351:1849-1859. – reference: 5) Engelen-Lee JY, Brouwer MC, Aronica E, et al. Pneumococcal meningitis: clinical-pathological correlations (MeninGene-Path). Acta Neuropathol Commun 201622;4:26. – reference: 22) Yanase T, Morii D, Kamio S, et al. The first report of human meningitis and pyogenic ventriculitis caused by Streptococcus suis: A case report. J Infect Chemother 2018;24:669-673. – reference: 19) 細菌性髄膜炎の診療ガイドライン2014作成委員会（日本神経学会，他監修）．細菌性髄膜炎診療ガイドライン2014．東京：南江堂；2014. – reference: 17) Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004;39:1267-1284. – reference: 15) 下畑享良，栁川香織，田中惠子ら．予後不良であった細菌性髄膜炎症例の臨床像の検討．臨床神経 2010;50:137-140. – reference: 16) Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2015;9:CD004405. – reference: 26) Jourani M, Duprez T, Roelants V, et al. Acute Bacterial Meningitis and Systemic Abscesses due to Streptococcus dysgalactiae subsp. equisimilis Infection. Case Rep Infect Dis 2017;2017:8645859. – reference: 28) Lo WB, Mitra R, Cadwgan A, et al. Pyogenic ventriculitis and the ‘lodge sign’. Acta Neurochir 2016;158:1849-1850. – reference: 3) Woehrl B, Linn J, Lummel N, et al. Pneumococcal meningitis-associated pyogenic ventriculitis. J Infect 2015;70:311-314. – reference: 29) Marinelli L, Trompetto C, Cocito L. Diffusion magnetic resonance imaging diagnostic relevance in pyogenic ventriculitis with an atypical presentation: a case report. BMC Res Notes 2014;7:149. – reference: 23) 中原広明，小田智三，深尾絵里ら．脳室炎を併発し，治療に難渋した髄膜炎菌性髄膜炎の1例．臨床神経 2016;56:344-347. |
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| Snippet | 症例は68歳男性．意識障害を主訴に救急搬送された．来院時のvital signs，血液所見，髄液所見から細菌性髄膜炎および敗血症性ショックと診断し，抗菌薬3剤によるempiric... |
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| SubjectTerms | MRI 化膿性脳室炎 抗菌薬療法 細菌性髄膜炎 肺炎球菌 |
| Title | 化膿性脳室炎を合併した細菌性髄膜炎における抗菌薬治療～自験例と症例報告の検討 |
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