摘要
目的 分析3例发生在广西的类鼻疽患者的临床特点,以提高临床医生的诊疗水平. 方法 回顾性分析广西医科大学第一附属医院2006年10月至2008年12月收治的3例类鼻疽患者的临床特点、诊疗过程及其转归. 结果 3例患者均为桂南及桂西南地区的青中年男性农民,平均年龄（42±2）岁,发病多在7～11月份,其中2例有长期皮肤外伤和接触污水史.1例有泥土接触史.3例患者均为急性起病,表现为败血症型,有畏寒、高热、贫血及明显消瘦等症状,合并多部位脓肿,脓液具有特殊的＂泥土＂味,1例为肺脓肿并右小腿皮肤化脓性感染,1例为肝、脾、胰及纵隔多发脓肿,1例为右侧颜面部和足部软组织化脓性感染.血常规检查3例患者血红蛋白水平均较低;2例患者平均白细胞总数[（11.6±0.5）×10^9/L]及中性粒细胞计数[（8.3 ±0.4）×10^9/L]增高,另1例患者两者均降低;3例患者ESR增快,平均为（63.5±2.7）mm/1 h,C反应蛋白增高,平均为（155±4）mg/L,均出现肝功能损害及血糖明显升高.肺部影像学检查多个肺叶或肺段可见斑片状浸润性阴影及大小不等的结节影,病灶以双上肺为主,并肝、脾、皮肤软组织等部位脓肿.3例血或脓液培养出类鼻疽伯霍尔德杆菌.首诊均误诊（肺炎、肺结核及普通败血症）.碳青酶烯类、β-内酰胺或β-内酰胺＋酶抑制剂敏感. 结论 患者以青壮年男性农民为主,有长期皮肤受损和污水或尘土接触史.类鼻疽伯霍尔德杆菌对碳青酶烯类及β-内酰胺＋酶抑制剂类抗生素敏感.建议静脉用药4～8周,总疗程4～6个月.
Objective To investigate the clinical features of 3 cases of Burkholderia pseudomallei septicemia in Guangxi Province.and therefore to improve its diagnosis and treatment. Method The clinical features.treatment and prognosis of 3 cases of acute septicemic melioidosis admitted to this hospital from October 2006 to December 2008 were retrospectively analyzed. Results The 3 male patients were local farmers,with an average age of （42 ±2）years.Two of them had a history of frequent trauma and contact with polluted water.and another had a history of exposure to the dust and soil.All patients had an acute onset,manifested as septicemia with chills,high-grade fever,anemia and weight loss.At the same time,the disease was often complicated with multiple organ abscesses.The pus wag characterized by smelling like mud.One case wag manifestated with lung abscess.with right calf skin pyogenic infection,and the another case was with liver,spleen,pancreas and mediastinal abscess,and the third presented with right facial and ankle soft tissue abscess.The leukocyte counts[（11.6 ±0.5）×10^9/L]and neutrophils[（8.3±0.4）×10^9/L] in 2 patients were slightly increased,but decreased in the other patient.There were significant increase of erythrocyte sedimentation rate（63.5±2.7）mm/1 h and c-reactive protein （155 ±4）mg/L,and liver dysfunotion and elevated blood glucose occurred in 3 patients.Chest radiology and CT showed a number of patchy infiltrates,consolidation,and nodules with varying sizes in the upper lung lobes.Abscess in other organs mainly occurred in liver,spleen.and skin.The final diagnosis was confirmed as infection with Burkholderia pseudomallei by repeated blood or pus culture.The isolated Burkholderia pseudonmallei wag sensitive to carbapenem,and β-lactam＋β-lactamage inhibitors.One patient was treated effectively with Imipenem,and other 2 patients with β-lactam＋β-lactamage inhibitors.After 3-4 days of treatment with antibiotics,the body temperature of these patients gradually decreased,and the intravenous drug wag used as long as 4 to 8 weeks.and a total course of antibiotic therapy would continue for 4 to 6 months. Conclusions Human melioidosis exists in the south and southwest of Guangxi.Repeated blood or pus culture can confirm the diagnosis.A relatively long course of antibiotic treatment with β-lactam/β-lactamage inibitors or carbapenem is recommended.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2010年第6期422-426,共5页
Chinese Journal of Tuberculosis and Respiratory Diseases
