外伤引起的类鼻疽伯克霍尔德菌致肺部感染合并败血症一例 ?(1)
【摘要】 类鼻疽伯克霍尔德菌引起的类鼻疽病缺乏特异性，容易漏诊、误诊。该文报道了1例由外伤接触类鼻疽伯克霍尔德菌引起的类鼻疽病患者诊疗过程。该例患者擦伤后出现不明原因发热，影像学检查右肺上叶尖后段模糊影，考虑炎症，予经验性抗感染治疗效果差，患者病情进展迅速，转入ICU，后在痰培养、血培养找到革兰阴性杆菌，鉴定为类鼻疽伯克霍尔德菌，并经16S rRNA扩增及测序比对示痰液和血液里的细菌为同一株菌。根据药物敏感试验结果选用美罗培南和多西环素联合治疗后病情转稳定，最后好转出院。该例诊治提示，类鼻疽伯克霍尔德菌引起的类鼻疽病缺乏特异性，主要侵犯肺部，早期对类鼻疽伯克霍尔德菌的正确鉴定以及根据药物敏感试验结果进行合理抗感染治疗对改善患者预后尤为重要。
【关键词】 类鼻疽病;肺部;败血症
【Abstract】 It is likely to miss diagnosis and misdiagnose melioidosis induced by Burkholderia pseudomallei due to lack of specificity. The diagnosis and treatment of one case of melioidosis induced by Burkholderia pseudomallei caused by trauma were reported. The patient suffered from unexplained fever after abrasion injury. Imaging examination revealed blurry shadow at the posterior segment of the right upper lung tip， which was suspected as inflammation. The patient was untreated with empirical anti-infection therapy and the disease progressed rapidly. The patient was transferred to ICU. Subsequent examination detected Gram-negative bacilli in the sputum and blood samples， which were identified as Burkholderia pseudomallei. The bacteria in the sputum and blood samples were the same strain by 16S rRNA amplification and sequencing analyses. According to the results of drug sensitivity test， meropenem combined with doxycycline was delivered. The physical condition of the patient became stable and discharged. The diagnosis and treatment of this case prompt that melioidosis induced by Burkholderia pseudomallei lacks of specificity， which mainly invades into the lung. Early identification of Burkholderia pseudomallei and reasonable anti-infection treatment based on drug sensitivity test results play a significant role in improving the clinical prognosis of patients.
【Key words】 Melioidosis;Lung;Septicemia
類鼻疽病是由类鼻疽伯克霍尔德菌引起的，该菌是一种革兰阴性短杆菌，可以引起人类和动物的共患疾病[1]。该病好发于东南亚和澳大利亚，在我国好发于广东、广西、福建、香港、台湾、海南等，其中海南是主要高发地区[2-6]。该病的主要传播途径是皮肤伤口接触、吸入或是食入受污染的土壤、水或尘土，临床表现多样，缺乏特异性，主要侵犯肺部，常造成肺炎，也可能侵犯肾、肝、脾、皮肤等器官，严重者可以出现败血症而死亡[7]。该病多发生于台风天气后，由于台风期间大量降水，使藏于深层泥土中的类鼻疽伯克霍尔德菌能够随雨水暴露于地表，从而增加了接触感染的机会[8]。2018年第21号台风“山竹”发生不久后，我院收治一例类鼻疽伯克霍尔德菌感染而引起败血症的患者，本文就其诊治过程进行分析，旨在为临床医师提供参考，现报告如下。
病例资料
一、病史及体格检查
患者男，44岁，农民。因畏寒、不明原因发热于2018年9月20日晚上20：30收入琼海市人民医院呼吸内科。患者自诉6 d前在从事挖掘机活动时不慎摔倒导致右小腿擦伤，并撞伤左胸，时有左胸部疼痛不适，4 d前因出现不明原因发热，在外院行胸部CT检查示：左侧第6前肋骨骨质改变，考虑裂纹性骨折;右肺上叶尖后段模糊影，考虑炎症，建议治疗后复查;胆囊多发结石。患者随后在外院诊治，治疗方案不详，由于治疗效果不佳，遂至我院求诊。
体格检查：体温39.0 ℃，脉搏100次/分，呼吸22次/分，血压115/77 mm Hg (1 mm Hg = 0.133 kPa)。神志清晰，精神稍疲倦。双肺呼吸音粗，可闻及少许湿性啰音。右小腿下段内侧可见约12 cm×5 cm擦伤，基本结痂，无渗液。, 百拇医药(陈映 吴华 王会玉 王妹妹 卢槐 莫海花)
【关键词】 类鼻疽病;肺部;败血症
【Abstract】 It is likely to miss diagnosis and misdiagnose melioidosis induced by Burkholderia pseudomallei due to lack of specificity. The diagnosis and treatment of one case of melioidosis induced by Burkholderia pseudomallei caused by trauma were reported. The patient suffered from unexplained fever after abrasion injury. Imaging examination revealed blurry shadow at the posterior segment of the right upper lung tip， which was suspected as inflammation. The patient was untreated with empirical anti-infection therapy and the disease progressed rapidly. The patient was transferred to ICU. Subsequent examination detected Gram-negative bacilli in the sputum and blood samples， which were identified as Burkholderia pseudomallei. The bacteria in the sputum and blood samples were the same strain by 16S rRNA amplification and sequencing analyses. According to the results of drug sensitivity test， meropenem combined with doxycycline was delivered. The physical condition of the patient became stable and discharged. The diagnosis and treatment of this case prompt that melioidosis induced by Burkholderia pseudomallei lacks of specificity， which mainly invades into the lung. Early identification of Burkholderia pseudomallei and reasonable anti-infection treatment based on drug sensitivity test results play a significant role in improving the clinical prognosis of patients.
【Key words】 Melioidosis;Lung;Septicemia
類鼻疽病是由类鼻疽伯克霍尔德菌引起的，该菌是一种革兰阴性短杆菌，可以引起人类和动物的共患疾病[1]。该病好发于东南亚和澳大利亚，在我国好发于广东、广西、福建、香港、台湾、海南等，其中海南是主要高发地区[2-6]。该病的主要传播途径是皮肤伤口接触、吸入或是食入受污染的土壤、水或尘土，临床表现多样，缺乏特异性，主要侵犯肺部，常造成肺炎，也可能侵犯肾、肝、脾、皮肤等器官，严重者可以出现败血症而死亡[7]。该病多发生于台风天气后，由于台风期间大量降水，使藏于深层泥土中的类鼻疽伯克霍尔德菌能够随雨水暴露于地表，从而增加了接触感染的机会[8]。2018年第21号台风“山竹”发生不久后，我院收治一例类鼻疽伯克霍尔德菌感染而引起败血症的患者，本文就其诊治过程进行分析，旨在为临床医师提供参考，现报告如下。
病例资料
一、病史及体格检查
患者男，44岁，农民。因畏寒、不明原因发热于2018年9月20日晚上20：30收入琼海市人民医院呼吸内科。患者自诉6 d前在从事挖掘机活动时不慎摔倒导致右小腿擦伤，并撞伤左胸，时有左胸部疼痛不适，4 d前因出现不明原因发热，在外院行胸部CT检查示：左侧第6前肋骨骨质改变，考虑裂纹性骨折;右肺上叶尖后段模糊影，考虑炎症，建议治疗后复查;胆囊多发结石。患者随后在外院诊治，治疗方案不详，由于治疗效果不佳，遂至我院求诊。
体格检查：体温39.0 ℃，脉搏100次/分，呼吸22次/分，血压115/77 mm Hg (1 mm Hg = 0.133 kPa)。神志清晰，精神稍疲倦。双肺呼吸音粗，可闻及少许湿性啰音。右小腿下段内侧可见约12 cm×5 cm擦伤，基本结痂，无渗液。, 百拇医药(陈映 吴华 王会玉 王妹妹 卢槐 莫海花)
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