細菌培養出現腦膜炎雙球菌之老年人慢性鼻及鼻竇炎

Geriatric Chronic Rhinosinusitis with Bacterial Culture of Neisseria Meningitidis

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen)

《台灣老年醫學暨老年學雜誌》 5卷3期 (2010/08) Pp. 228-233

https://doi.org/10.29461/TGG.201008.0007

摘要

成人慢性鼻及鼻竇炎以Staphylococcus屬、Streptococcus屬及Klebsiella屬感染為多。腦膜炎雙球菌是一種格蘭氏陰性嗜氧菌，其感染會造成很多嚴重的臨床症狀，若出現在慢性鼻及鼻竇炎的細菌培養結果實屬罕見。一68歲女性，因右側鼻塞及膿鼻涕半年而求診，診斷為右側慢性鼻及鼻竇炎合併過敏性鼻炎，先給予抗組織胺及鼻用類固醇治療。前兩次細菌培養（間隔1週）均顯示金黃色葡萄球菌及腦膜炎雙球菌，腦膜炎雙球菌呈現多重抗藥性，僅對ceftriaxone呈現敏感性，仍繼續保守治療，並未給予任何抗生素。第3次細菌培養僅顯示金黃色葡萄球菌，始給予2週之敏感抗生素trimethoprim/sulfamethoxazol治療。本個案共經過3個月的保守治療及追蹤，慢性鼻及鼻竇炎已經緩解。可見，老年人慢性鼻及鼻竇炎之細菌培養結果會出現腦膜炎雙球菌，應為該菌種之合併感染，本個案之病症與其他成人慢性鼻及鼻竇炎相當類似，建議先藥物保守治療，並配合局部治療。有關老年人鼻及鼻竇炎的研究論文目前仍缺，期待未來能有更多的研究，探討其細菌培養及治療方式是否與一般成年鼻及鼻竇炎有所不同。

關鍵字

鼻及鼻竇炎 ； 鼻竇X光 ； 腦膜炎鏈球菌 ； 細菌培養 ； 局部治療

並列摘要

Adult chronic rhinosinusitis is commonly attributable to infection of Staphylococcus, Streptococcus, and Klebsiella species. Neisseria meningitidis is a Gram-negative bacterium and contributes to many serious clinical symptoms. Chronic rhinosinusitis with bacterial culture of Neisseria meningitidis is a rare curiosity. A 68-year-old woman presented with right side nasal stuffiness and purulent rhinorrhea for half a year. She was diagnosed with right side chronic rhinosinusitis and allergic rhinitis; an oral antihistamine and an intranasal corticosteroid were accordingly recommended. Both the first and second bacterial cultures with an interval of one week reported Staphylococcus aureus and Neisseria meningitidis. The Neisseria meningitides was multi-resistant and only sensitive to ceftriaxone. The patient was treated conservatively without any antibiotic till the third bacterial culture reported simply Staphylococcus aureus. Then the sensitive antibiotic, trimethoprim/sulfamethoxazol, was applied over the following two weeks. She had been treated conservatively for three whole months before the chronic rhinosinusitis subsided. Therefore, Neisseria meningitides could be one result of the bacterial culture of geriatric chronic rhinosinusitis. Simultaneous infection of this bacterial species was impressive in this case, and its symptom was similar to that of a common adult chronic rhinosinusitis. Conservative treatment with local treatment is recommended. The bacteriology and therapeutic recommendation of geriatric rhinosinusitis in comparison with common adult rhinosinusitis should merit further researches in the future.

並列關鍵字

rhinosinusitis ； sinus X-ray ； Neisseria meningitidis ； bacterial culture ； local treatment