立克次体感染并发肺血栓栓塞症一例并文献复习
Rickettsial infection complicated with pulmonary thromboembolism:a case report and literature review
谭聪 1徐敏 1王鹏飞 1赵丽芬 1魏双 2刘先胜2
作者信息
- 1. 山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院)(山西太原 030032)
- 2. 山西医科大学第三医院(山西白求恩医院山西医学科学院同济山西医院)(山西太原 030032);华中科技大学同济医学院附属同济医院呼吸与危重症医学科(湖北武汉 430030)
- 折叠
摘要
目的 分析立克次体感染并发肺血栓栓塞症的临床特点,提高临床医师对立克次体感染并发血栓栓塞事件的认识.方法 回顾性分析1例猫立克次体感染并发肺血栓栓塞症患者的临床资料,并进行相关文献复习.以"立克次体/恙虫病,血栓"或"立克次体/恙虫病,栓塞"为中文检索词,分别检索中国知网、万方数据库、维普数据库,以"Rickettsia/Scrub typhus,thrombosis"及"Rickettsia/Scrub typhus,embolism"为英文检索词,检索PubMed数据库,检索时间均为1985年1月-2023年5月.结果 本例81岁男性患者,因"头晕、咽痛11天,发热7天,气促3天"于2021年6月1日入院.体检发现左耳后有焦痂样皮疹,双下肢彩超见静脉血栓形成,CT肺动脉造影提示双肺多发肺动脉栓塞,外周血二代测序结果提示猫立克次体阳性,确诊为猫立克次体感染并发双下肢静脉血栓栓塞症(venous thromboembolism,VTE)及肺栓塞.文献检索经筛选后纳入中文文献2篇,英文文献18篇,其中猫立克次体感染并发血栓栓塞事件暂未检索到相应文献,共纳入21例病例.21例中并发下肢VTE6例,肺栓塞10例,颅内静脉血栓5例,其他部位血栓(如颈静脉血栓、肠系膜血栓、主动脉血栓等)6例,其中同时累及全身多系统血栓形成的有8例.4例死亡病例中,2例为肠系膜栓塞,1例为脑梗死,1例表现为全身多发血栓.结论 立克次体感染症状体征常不典型,可以并发下肢VTE或肺栓塞.早期筛查识别、早期诊治非常重要,尤其对于出现呼吸困难、胸痛等症状的患者.
Abstract
Objective To analyze the clinical features of rickettsial infection complicated with pulmonary embolism and to improve clinicians'knowledge of rickettsial infection complicated by thromboembolism events.Methods We retrospectively analyzed the clinical data of a patient with pulmonary thromboembolism complicated by Rickettsial felis infection and conducted a review of the relevant literature.The search terms"Rickettsia/Scrub typhus,thrombosis"or"Rickettsia/Scrub typhus,embolism"were used to search the Wanfang,VIP,Chinese National Knowledge Infrastructure and PubMed databases from January 1985 to May 2023,respectively.Results The 81-year-old male patient was admitted to the hospital on June 1,2021 due to"dizziness,sore throat for 11 days,fever for 7 days,and shortness of breath for 3 days".Physical examination revealed a eschar-like rash behind the left ear,venous thrombosis in both lower limbs was detected by color ultrasound,computed tomographic pulmonary angiography indicated multiple pulmonary embolism in both lungs,and positive rickettsiae on peripheral blood next-generation sequencing,confirming the diagnosis of Rickettsial felis infection complicated by venous thromboembolism(VTE)in both lower limbs and pulmonary embolism.Twenty manuscripts,including 20 cases,were retrieved from databases.Among them,Rickettsial felis infection combined with thromboembolism event was not found.With the addition of our case,a total of 21 cases were analyzed in detail.Six of the 21 cases were complicated with VTE,10 with pulmonary embolism,5 with intracranial venous thrombosis,6 with thrombosis at other sites(jugular venous thrombosis,mesenteric thrombosis,aortic thrombosis,etc),and 8 of which had concurrently involved systemic thrombosis.Of the 4 deaths,2 cases had mesenteric embolism,1 case had cerebral infarction,and 1 case had systemic multiple thrombus.Conclusions Rickettsial infection symptoms and signs are often atypical,can be complicated with lower limb VTE or pulmonary embolism.Early identification,diagnosis and treatment are very important,especially for patients with dyspnea,chest pain and other related symptoms.
关键词
立克次体/肺栓塞/深静脉血栓/血栓事件Key words
Rickettsial/pulmonary embolism/venous thromboembolism/thromboembolism events引用本文复制引用
基金项目
山西省"四个一批"科技兴医创新计划项目(2023XM003)
出版年
2024
NETL
NSTL
万方数据