肝门部胆管癌术后非01/非0139群霍乱弧菌血流感染1例并文献复习
Non-O1/non-O139 Vibrio cholerae bloodstream infection after operation for hilar cholangiocarcinoma:a case report and literature review
王洁 1张瑜 1李苹苹 2帖彦清1
作者信息
- 1. 河北省人民医院检验科,河北省医学检验临床医学研究中心,河北省分子医学重点实验室,石家庄 050051
- 2. 河北省人民医院消化科,河北省医学检验临床医学研究中心,河北省分子医学重点实验室,石家庄 050051
- 折叠
摘要
目的 了解非01/非0139群霍乱弧菌感染的流行病学特征、临床表现、诊断及治疗,以期提高对该病的认识.方法 对1例非01/非0139群霍乱弧菌血流感染患者的临床表现、实验室检查、治疗及转归进行回顾性分析,并以"非01/非0139群霍乱弧菌"和"血流感染"为主题词,检索万方、维普和中国知网数据库,以"non-01/non-0139 Vibrio cholerae"和"bloodstream infection"为主题词检索PubMed数据库,获取国内外报道的病例,复习非01/非0139群霍乱弧菌血流感染的临床特征及诊疗方法.结果 该例69岁男性患者肝门部胆管癌术后6个月,腹胀、发热、无腹泻,血培养检测出霍乱弧菌,经质谱、VITEK 2XL和16S rRNA基因鉴定均为霍乱弧菌,血清学确认为非01/非0139群.使用哌拉西林抗感染治疗10 d后,患者康复出院.通过文献复习发现26例非01/非0139群霍乱弧菌血流感染患者大多数有慢性肝炎、肝硬化等消化道基础疾病,主要症状为急性腹泻、腹胀腹痛、发热、恶心、呕吐等.菌株对多种抗菌药物敏感,予抗感染及对症治疗后80.77％患者好转出院,15.38％死亡,主要因感染性休克引起的多器官衰竭而死亡.结论 非01/非0139群霍乱弧菌血流感染好发于免疫功能低下者,尤其是慢性肝炎、肝硬化、恶性肿瘤、糖尿病患者,及时血培养检查和准确鉴定对其诊断非常重要.早期应用敏感抗生素治疗预后相对较好.
Abstract
Objective To investigate the epidemiological characteristics,clinical manifestations,diagnosis and treatment of non-O1/non-O139 Vibrio cholerae infection in order to improve the understanding of the disease.Methods A retrospective analysis was conducted on the clinical manifestations,laboratory examinations,treatment,and outcomes of a patient with non-O1/non-O139 Vibrio cholerae bloodstream infection.Relevant cases were identified by searching Wanfang,VIP,CNKI,and PubMed databases using the keywords"non-O1/non-O139 Vibrio cholerae"and"bloodstream infection".The clinical characteristics and diagnosis and treatment methods of non-O1/non-O139 Vibrio cholerae bloodstream infection were reviewed.Results Six months after the operation for hilar cholangiocarcinoma,the 69-year-old male patient experienced abdominal distention,fever,but no diarrhea.Blood culture found Vibrio cholerae,which was identified as Vibrio cholerae by mass spectrometry,VITEK 2XL,and 16S rRNA gene.The serology test confirmed it as non-O1/non-O139 group.After 10-day treatment with piperacillin,the patient recovered and was discharged from hospital.Literature review showed that most of the 26 patients with non-O1/non-O139 Vibrio cholerae bloodstream infection had underlying diseases of chronic hepatitis,cirrhosis or other digestive tract diseases.The main symptoms were acute diarrhea,abdominal distention and pain,fever,nausea and vomiting.The strain was susceptible to a variety of antibiotics.After antimicrobial and symptomatic treatment,80.77％of the patients were discharged.Overall,15.38％of the patients died,mainly due to multiple organ failure caused by septic shock.Conclusions Bloodstream infection caused by non-O1/non-139 Vibrio cholerae tends to occur in patients with immune deficiency,especially in patients with chronic hepatitis,cirrhosis,malignant tumor,or diabetes mellitus.Timely blood culture and accurate identification of pathogen are very important for diagnosis.Early use of active antimicrobial agents will lead to a relatively good outcome.
关键词
非01/非0139群霍乱弧菌/肝硬化/血流感染Key words
non-O1/non-O139 Vibrio cholerae/liver cirrhosis/bloodstream infection引用本文复制引用
基金项目
河北省医学科学研究项目(2022)(20220929)
出版年
2024
NETL
NSTL
万方数据