一唇顎裂幼兒感染盤尼西林抗藥性草綠色鏈球菌所引起的腦膜炎：病例報告

A Penicillin-Resistant Strain of Viridans Streptococci Meningitis in an Infant with Cleft Lip and Palate: A Case Report

細菌性腦膜炎在基層醫療並不少見，一般來說，此病症的診斷並不困難，但發生在新生兒及幼兒時，因症狀、理學檢查及致病原因和成人有所不同，因而增加診斷的困難。本病例是一位兩個月大的男嬰先天有唇顎裂並裝有矯正器，最近兩週持續咳嗽，住院當天呈現敗血性休克併伴隨意識喪失及抽搐的現象，經一系列檢查後，發現腦脊髓液培養出盤尼西林抗藥性的草綠色鏈球菌(viridans, streptococci)，最後經過兩週的抗生素(cefotaxime)治療後出院，於門診追蹤複查之情況良好。本文目的，希望藉此病例提醒基層醫師，在面對顏面部有缺損（如唇顎裂）的幼兒罹患上呼吸道感染時，如治療後仍未改善，要嚴密觀察病況是否發展成腦膜炎之可能性，即使是毒性較弱的草綠色鏈球菌，也可能造成嚴重的感染。此外，藉由回顧相關文獻，企盼能讓基層醫師對於幼兒型腦膜炎及草綠色鏈球菌有更深一層的了解。

Bacterial meningitis is unfortunately commonplace in primary care practices. Compared to adults, it is more difficult to make the diagnosis in newborn and young children, in part due to different clinical presentations, physical examination findings, and etiology. Many pathogens, including viridans streptococci can cause meningitis. We report a case of bacterial meningitis in a two month-old male infant who had cleft lip and palate, and wore an acrylic plate. He was admitted to the hospital because of a two-week history of a cough. On the first hospital day, he manifested symptoms of septic shock, unconsciousness, and seizure activity. Bacterial cultures of the cerebrospinal fluid revealed a penicillin-resistant strain of viridans streptococci, He responded well to a two-week course of cefotaxime and was discharged home without complications. We report this case and reviewed the pertinent literature to provide primary care physicians a better understanding of meningitis induced by viridans streptococci and to emphasize the importance of acquiring a detailed history from the child's family members.