Extracorporeal membrane oxygenation in acute respiratory distress syndrome caused by elderly tuberculous meningitis: a case report and review of the literature

IF 3.1 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Frontiers in Medicine Pub Date : 2024-09-18 DOI:10.3389/fmed.2024.1457413

Zhaokun Shi, Xue Zhu, Wenwei Gao, Shuhui Yu, Liying Zhan

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引用次数: 0

Abstract

Diagnosing and clinical management of tuberculous meningitis (TBM) are still challenging for clinicians. Analysis of cerebrospinal fluid (CSF) is an important diagnostic tool for patients with suspected central nervous system (CNS) diseases. Acute respiratory distress syndrome (ARDS), an inflammatory lung injury, can be treated by mechanical ventilation, fluid management, and even extracorporeal membrane oxygenation (ECMO). In addition, metagenomic next-generation sequencing (mNGS) can facilitate the detection of atypical, rare pathogens in clinical specimens. We report a case of a 65-year-old man with ARDS caused by TBM. He was admitted with a fever and shaking. Despite aggressive initial treatment, the patient progressed rapidly and developed ARDS. Without positive results of mNGS and culture, anti-tuberculosis (TB) treatment was started. In order to improve oxygenation levels, he was placed on veno-venous ECMO for 8 days. On day 47, the tracheotomy catheter was pulled out and sealed. The patient was conscious and could communicate with family members as normal.

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体外膜肺氧合治疗老年结核性脑膜炎引起的急性呼吸窘迫综合征：病例报告和文献综述

对于临床医生来说，结核性脑膜炎（TBM）的诊断和临床治疗仍是一项挑战。脑脊液（CSF）分析是诊断疑似中枢神经系统（CNS）疾病患者的重要工具。急性呼吸窘迫综合征（ARDS）是一种炎症性肺损伤，可通过机械通气、液体管理甚至体外膜肺氧合（ECMO）来治疗。此外，元基因组下一代测序（mNGS）有助于检测临床标本中的非典型、罕见病原体。我们报告了一例由 TBM 引起 ARDS 的 65 岁男性病例。他因发烧和颤抖入院。尽管最初进行了积极的治疗，但患者病情进展迅速，出现了 ARDS。在 mNGS 和培养结果均为阳性的情况下，患者开始接受抗结核（TB）治疗。为了改善氧合水平，他接受了为期 8 天的静脉-静脉 ECMO 治疗。第 47 天，气管切开导管被拔出并密封。患者意识清醒，可以正常与家人交流。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Medicine Medicine-General Medicine

CiteScore

5.10

自引率

5.10%

发文量

3710

审稿时长

12 weeks

期刊介绍： Frontiers in Medicine publishes rigorously peer-reviewed research linking basic research to clinical practice and patient care, as well as translating scientific advances into new therapies and diagnostic tools. Led by an outstanding Editorial Board of international experts, this multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide. In addition to papers that provide a link between basic research and clinical practice, a particular emphasis is given to studies that are directly relevant to patient care. In this spirit, the journal publishes the latest research results and medical knowledge that facilitate the translation of scientific advances into new therapies or diagnostic tools. The full listing of the Specialty Sections represented by Frontiers in Medicine is as listed below. As well as the established medical disciplines, Frontiers in Medicine is launching new sections that together will facilitate - the use of patient-reported outcomes under real world conditions - the exploitation of big data and the use of novel information and communication tools in the assessment of new medicines - the scientific bases for guidelines and decisions from regulatory authorities - access to medicinal products and medical devices worldwide - addressing the grand health challenges around the world