摘要
目的提高对溶血隐秘杆菌致Lemierre综合征的认识及诊治水平。方法分析1例溶血隐秘杆菌致Lemierre综合征的临床特点，并进行文献复习。结果患者男，无诱因发热伴咽痛，体检发现左侧扁桃体充血、肿大，血常规正常，x线胸部正位片未见异常。初步诊断：急性扁桃体炎（左侧）。予青霉素＋阿奇霉素治疗后，症状加重，查白细胞计数13．59×10^9／L，中性粒细胞比例0．933，血小板计数7．4×10^9／L；TBil54．3mmol／L，DBil28．3mmol／L，AST127IU／L，ALT82IU／L，血清白蛋白19．3g／L。血培养结果为溶血隐秘杆菌，改静脉滴注哌拉西林一他唑巴坦治疗后体温恢复正常。随后患者出现左侧颈内静脉血栓形成，予抗凝治疗。出院后2个月和4个月时随访患者，未见异常。检索文献3例，结合本例共4例，4例患者均为男性，年龄19—54岁，均以咽痛和发热为首发和主要症状，均伴有颈部疼痛；咽炎2例，扁桃体周围渗出或脓肿各1例，皮疹2例；血白细胞计数均升高，血小板计数均下降，肝功能损伤3例，急性肾衰竭2例，急性呼吸衰竭1例；首查X线胸片均正常，病情进展后胸部X线或CT提示双肺周边多发结节高密度影伴空洞形成3例，局灶或楔形浸润影1例，胸腔积液1例；血培养结果提示单一溶血隐秘杆菌2例，溶血隐秘杆菌和坏死梭形杆菌复合感染2例；4例患者均应用青霉素＋酶抑制剂治疗有效；有血栓者予抗凝治疗；无死亡病例。结论Lemierre综合征临床特点有原发口咽部感染、脓毒血症、感染性或栓塞性颈静脉炎及至少一处远处化脓灶，早期诊断、及时治疗可降低溶血隐秘杆菌致Lemierre综合征病死率。
Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum. Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed. Results A man complained of fever with a sore throat, and examination found an enlarged left tonsil with prominent exudate, normal blood routine test and chest radiograph. Although the patient received the treatment of penicillin G and azithromycin, his condition worsened. Blood test showed white blood cell count 13.59 ×10^9/L （neutrophils 0. 933 ）, platelet count 7.4 ×10^9/L, TBil 54. 3 mmol/L, DBil 28.3 mmol/L, AST 127 IU/L, ALT 82 IU/L, serum albumin 19. 3 g/L with the development of the conditions. Blood cultures grew Arcanobaeterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled. In addition, anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein. Two follow-up clinic visits over the following 4 months were unremarkable. Besides three similar cases reported, four patients were male, and the ages ranged from 19 to 54 years. The chief complaints were sore throat and fever （4/4）, with neck pain （4/4）. Physical examinations found pharyngitis （2/4）, exudate or abscess in the tonsillar crypt （2/4）, maculopapular rashes （2/4）. Laboratory results showed leukocytosis and thrombocytopaenia （4/4）, acute cholestatic liver dysfunction （3/4）, acute renal failure （2/4）, acute respiratory failure （1/4）. The first chest radiographs were normal at the onset, but chest radiography features included peripheral nodules and cavitation （ 3/4 ）, focal or wedge-shaped lesions （ 1/4 ）, pleural effusion （1/4） with the development of the conditions. Blood culture proved that there was only growth of Arcanobacterium haemolyticum （2/4）, both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found （2/4）. Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered （4/4）. Neck CT proved internal jugular vein thrombosis （3/4） and anticoagulation was administered （3/4）. All patients recovered and no one died. Conclusions The characters of Lemierre syndrome include primary oropharynx infection, septicaemia, septic or embolic phlebitis of jugular vein, and metastatic abscess. Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2013年第1期42-45,共4页
Chinese Journal of Internal Medicine
