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Vojnosanitetski pregled
2020, vol. 77, br. 7, str. 758-761
jezik rada: engleski
vrsta rada: prikaz slučaja
objavljeno: 12/08/2020
doi: 10.2298/VSP180619146M
Creative Commons License 4.0
Listeria monocytogenes multifokalni cerebritis kod imunokompetentnog bolesnika
Milošević Brankoa, Urošević Aleksandara, Nikolić Natašaa, Milošević Ivanaa, Poluga Jasminaa, Tošić Tanjab, Jovanović Milicab
aUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za infektivne i tropske bolesti, Beograd
bKlinički centar Srbije, Služba za mikrobilogiju, Beograd

e-adresa: mijovan@eunet.rs

Sažetak

Uvod. Multifokalni cerebritis koji uzrokuje Listeria monocytogenes je retko i teško oboljenje koje je u literaturi opisano samo u nekoliko slučajeva. Prikaz bolesnika. Bolesnik star 64 godine primljen je u bolnicu poremećene svesti (Glasgow Coma Scale skor: 9) nakon 16 dana prethodne febrilnosti, glavobolje i bola u desnom uvu. Nije imao drugih prethodnih bolesti, niti je bio imunokompromitovan. Dobijen je podatak o alergiji na penicilin. Pri neurološkom pregledu nisu evidentirani meningealni znaci i fokalni neurološki poremećaji, a snimak endokranijuma kompjuterizovanom tomografijom sa kontrastom pokazao je tri hipodenzne zone u okcipitalnom i jednu u desnom temporalnom lobusu. Laboratorijski nalazi u krvi i cerebrospinalnoj tečnosti upućivali su na infektivnu prirodu promena u endokranijumu (multifokalni cerebritis). Incijalna terapija bila je kombinacija cefotaksima, amikacina i metronidazola, a nakon izolacije L. monocytogenes u kulturi cerebrospinalne tečnosti i hemokulturi, terapija je zamenjena ko-trimoksazolom. Oporavak stanja svesti sa uspostavljanjem budno-svesnog stanja nastupio je nakon šest dana od primene ko-trimoksazola. Ukupno trajanje terapije ko-trimoksazolom iznosilo je 36 dana. U tom periodu normalizovali su se svi klinički i laboratorijski parametri. Bolesnik je otpušten kao oporavljen, sa sekvelama amnezije i usporenog govora. Zaključak. U lečenju multifokalnog cerebritisa uzrokovanog L. monocytogenes neophodan je adekvatan izbor i dugotrajna primena antibiotske terapije. Lek izbora je ampicilin, ali u slučaju alergije na njega, ko-trimoksazol predstavlja dobru zamenu.

Ključne reči

meningitis, listeria; infekcija, listerija; antibiotici, kombinovani; kotrimoksazol; tomografija

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