摘要
本文報告一例台灣罕見的單核細胞增多性李斯特菌腦膜炎。病人60歲女性，糖尿病患者，入院主訴發燒、畏寒、全身不適並頭痛約6天。發病前一週，參加旅遊團至中部，攝食水果生菜沙拉、乳酪、果醬及現榨水果汁。理學檢查顯示反應遲鈍、頸部僵硬，雙手顫抖且感覺異常，意識時而清析時而混淆。實驗室檢查：血液白血球數在正常範圍，但單核球高達8.9%。腦脊髓液檢查：紅血球數210(/cmm)；白血球數370(/cmm)，淋巴球：嗜中性白血球＝54:46；糖值40mg/dl；蛋白質450mg/dl；細菌培養：單核細胞增多性李斯特菌(Listeria monocytogenes)。腦部電腦斷層及腦部MRI均無明顯特殊變化。腦波檢查：mild diffuse cortical dysfunction over bilateral hemisphere。住院後分別投予靜脈注射PenicillinG 300萬單位q4h, Gentamicin 60mg q12h及口服Bakter 2#bid。意識在五天之內恢復正常；頭痛、頸部僵硬、上肢顫抖及感覺異常亦皆逐漸改善，情況穩定，於五週後出院。追蹤約一年，並無神經性後遺症，且未再復發。單核細胞增多性李斯特菌感染之臨床表現，以未知病灶之菌血症最常見，其次為腦膜炎，此菌對中樞神經系統有特殊的親和力。本案腦膜炎伴有中樞神經變化，嚴格說應屬腦膜腦炎。感染源恐係來自遭污染之水果生菜沙拉、乳酪及現榨水果汁，潛伏期似嫌不足，但仍不可排除。建議孕婦、老年人、經免疫抑制移植者、罹患血液惡性腫瘤及細胞免疫受損者，盡量避免食用軟乳酪；對於ready-to-eat 食物，如熱狗等，須先加熱；水果及蔬菜須洗乾淨；肉類食物須徹底烹煮，以避免遭受單核細胞增多性李斯特菌感染。
並列摘要
We report a case of Listeria monocytogenes meningitis, which is a rare disease in Taiwan. A 60-year-old female with diabetes mellitus was admitted due to fever, chills, general discomfort, and a headache that had persisted for 6 days. The patient had traveled to central Taiwan one week prior to developing these symptoms. Her diet during the trip consisted of fruit-vegetable salad, jam, cheese, and fresh fruit juice. Physical examination revealed stupor consciousness, nuchal rigidity, hand tremors, and paraesthesia. The white blood cell count was normal, but a increased level of monocytes (8.9%) was noted. Analyses of cerebrospinal fluid revealed a red blood cell count of 210 (/cmm), white blood cell count of 370 (/cmm), lymphocyte:neutrophil ratio of 54:46, glucose concentration of 40 mg/dl, and protein level of 450 mg/dl. Culture of the cerebrospinal fluid yielded L. monocytogenes. Computed tomography and magnetic resonance imaging examinations of the brain did not reveal significant changes from normal. Electroencephalography showed a mild diffuse cortical dysfunction over the bilateral hemisphere. Treatment consisted of penicillin G (3 million units q4h intravenously), gentamicin (60 mg q12h via an intravenous drip), and baktar 2# bid P.O. The patient regained consciousness on the fifth day of hospitalization; thereafter, the headache, nuchal rigidity, tremors, and paraesthesia subsided gradually. The patient was discharged in stable condition five weeks after the date of admission. No relapse occurred and neurologic sequelae were not detected during the following year. The most common manifestation of listeriosis is bacteremia without an evident focus, followed by meningitis. L. monocytogenes avidly infects the central nervous system. The patient's symptoms of altered consciousness and disrupted movement disorder that subsided upon antibiotic treatment are entirely consistent with meningoencephalitis. It is conceivable that she acquired the infection from eating contaminated fruit-vegetable salad, cheese, or fresh fruit juice, although the incubation period would have been shorter than is classically the case. Nonetheless, we suggest that thorough washing of raw vegetables and fruit, adequate cooking of raw meat, reheating of ready-to-eat foods such as hotdogs before eating, and refraining from eating soft cheese are prudent precautions to avoid listeriosis, especially in pregnant women, elderly people, those who are immunocompromised and/or have impaired cell-mediated immunity, and those with hematologic malignancies.