Analysis of Clinical Diagnosis and Treatment of a Patient with Rare Bloodstream Infection Caused by Malassezia Restricta
Objective:To analyze the clinical diagnosis and treatment process of a patient with rare bloodstream infection caused by Malassezia restricta,and provide reference for the clinical diagnosis and treatment of such rare infectious diseases.Methods and Results:The patient had recurrent fever after being scratched by a cat 2 weeks ago,and continued to have fever after admission.The examination showed that the WBC count and procalcitonin in serum were normal,and only the C-reactive protein(CRP)increased.According to the patient's clinical symptoms,the respiratory tract and urinary tract infections were clinically ruled out,and no other obvious foci of infection were found.Clinically,azithromycin was given empirically;2 days later,the fungal D-glucan test results were abnormal(222.53 pg/mL);the clinical pharmacist consultation revealed that the patient had recently suffered from poor control of blood glucose in diabetes and had taken glucocorticoids,so his/her immune functions might be poor.Based on the patient's previous examination results,it was suspected that the patient's fever was possibly caused by bloodstream infection when fungi invaded the blood as a result of cat scratch,so it was suggested to add fluconazole for antifungal treatment;on the 2nd day,the patient's body temperature dropped apparently,and on the 3rd day,the next-generation sequencing results of the patient's blood samples showed that the bacterium was Malassezia restricta(sequence number:29),which basically confirmed the judgment of the clinical pharmacist;finally,the patient was discharged from the hospital 10 days after treatment with fluconazole.Conclusion:For any patient with fever of unknown origin,clinicians and pharmacists should accurately determine the patient's infection site and possible pathogenic bacteria according to the patient's clinical manifestations and various examination results,as well as feedback from empirical anti-infective treatment,so as to provide more targeted and effective treatment for the patient.
fever of unknown originbloodstream infectionMalassezia restrictapharmaceutical carefluconazole
NETL
NSTL
万方数据
维普
