NEJM：揭示被污染的甲泼尼龙注射所引发的真菌性脑膜炎

2012年10月25日--随着真菌性脑膜炎发病案例在美国持续地增长，医生们面临着如何提供早期的疗法来治疗患者，近日，刊登在国际杂志NEJM上的研究报告中，来自密歇根大学的研究者报道了真菌性脑膜炎爆发的情况以及相应的抗真菌性脑膜炎的相关疗法。

研究者表示，超过200名病例都是因为患者注射了受感染的类固醇导致的，很大一部分患者都为成年人，其中有许多患者都有共存性疾病，这就使得治疗难度加大。推荐的疗法会随着研究者研究的深入而不断改进，目前对于被感染的病人，医生们使用的是一定剂量的伏立康唑，这会引发患者一些副作用，包括视觉障碍、意识错乱、幻觉、恶心以及肝脏异常等。

研究者Kauffman表示，目前关于伏立康唑的毒性研究者们比较关注，尤其是治疗真菌性脑膜炎的推荐剂量。而且这也存在明显的药物-药物作用，对于已经服用药物如血液稀释剂他汀类药物等的患者，服用伏立康唑应该等待患者服用完其它药物后再进行合理服用。

来自疾控中心的建议，人们如果感觉患病的话，应该及时寻找医生，而且医生必须知道真菌性脑膜炎的症状，而且可以进行快速的诊断和有效的措施来预防患者的病情恶化或者死亡。真菌性脑膜炎爆发初期会出现头痛、发烧、恶心以及颈强直症状，这是在注射污染类固醇后四周后的表现。

与脑膜炎相关的拓展阅读：

• BMC Medicine：二手烟或增加儿童侵入性脑膜炎球菌的感染
• Ann Inter Med：揭示颈部药物注射所引发的真菌性脑膜炎
• AAN 2013：真菌性脑膜炎新型检测方法
• Clin Infect Dis：三种社交活动或增加大学生患脑膜炎风险
• NEJM：两性霉素B联合氟胞嘧啶治疗隐球菌性脑膜炎效果优于单药 更多信息请点击：有关脑膜炎更多资讯

Fungal Infections Associated with Contaminated Methylprednisolone Injections — Preliminary Report

We are in the midst of an unprecedented outbreak of fungal infections associated with epidural injection of methylprednisolone that was contaminated with environmental molds. The index case, which prompted clinicians at Vanderbilt to call the Tennessee Department of Health and which brought this event to national attention, is now reported by Pettit et al. in the Journal.1 The persistence and progression of neutrophilic meningitis of unknown cause was the trigger for obtaining the history of a recent epidural injection of methylprednisolone. Then events fell into place. After the alarm was sounded about this association, other physicians throughout the country realized that they too had struggled to find a cause for similar cases in recent weeks. What is intriguing about this case report is that the mold causing meningitis was reported to be Aspergillus fumigatus, an organism that has not been detected in any of the subsequent 200-plus cases. The major culprit appears to be Exserohilum rostratum, a plant pathogen that rarely causes human disease. This mold has been cultured or identified by means of a polymerase-chain-reaction (PCR) assay from cerebrospinal fluid in at least 25 patients and has been detected in at least one unopened vial from the implicated lot of methylprednisolone.