中间型葡萄球菌肺炎一例报告并文献复习  

Pneumonia Caused by Staphylococcus intermedius:A Case Report and Literature Review

作　　者：谢红旗[1] 刘卫[1] 曾春艳[1] 林岩[1] 黄连江[2] 

机构地区：[1]厦门市第二医院呼吸中心,福建厦门361021 [2]厦门市第二医院微生物检验室,福建厦门361021

出　　处：《中国呼吸与危重监护杂志》2016年第1期26-29,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的总结中间型葡萄球菌感染的临床特征及鉴别诊断。方法采用临床病例分析并结合相关文献复习。文献源自CNKI数字图书馆数据库、万方医学数据库,检索1998-2015年的国内中文医学期刊中涉及中间型葡萄球菌感染的临床及实验室文献报告。结果本例患者为35岁男性,以＂咳嗽,咳痰伴发热3 d＂为主诉。胸部CT平扫：右肺上叶后段见楔形、絮状高密度影,边界不清,内可见支气管充气征,右肺下叶胸膜下见模糊影,右侧胸腔背侧见少许弧形液性密度影。将支气管镜下右上叶段口吸引痰液接种于哥伦比亚血琼脂平板、巧克力琼脂平板行细菌鉴定,结果为中间型葡萄球菌。确诊为中间型葡萄球菌肺炎,使用氟罗沙星0.4 g qd静脉滴注。2周后复查胸部CT平扫,与入院时对比右肺上叶后段炎症较前吸收,右肺下叶炎症基本吸收,右侧胸腔积液基本吸收。文献复习：国内报告4例中间型葡萄球菌感染者,3例为儿童;表现有脑膜脑炎、关节感染、肺部感染、败血症及外伤或狗咬伤后伤口感染;血、痰、脑脊液、伤口脓液培养鉴定为中间型葡萄球菌;敏感抗菌药物治疗有效。结论中间型葡萄球菌感染部位及临床表现有多样性;多部位多种类型的采集标本可获阳性培养;细菌培养与金黄色葡萄球菌容易混淆,应仔细鉴别;临床治疗应早期选用高敏感药物,预后较好。Objective To summarize the clinical features of infection with Staphylococcus intermedius and its differential diagnosis. Methods A clinical case of Staphylococcus intermedius infection was analyzed and Chinese literatures about Staphylococcus intermedius infection were reviewed. The literatures were derived fromdomestic medical journals in CNKI Digital Library and Wanfang Databases from1998 to 2015. Results The patient was a 35-year-old male. The chief complaints were cough and sputumassociated with fever for three days. Chest CT scan showed cuneate and flocculent shadow with high density and unclear margin in the posterior segment of the right upper lobe and aerated bronchus sign was seen. Fuzzy shadow under the pleural was observed in the right lower lobe; On the right side of the chest, a little curved liquid density was seen. Sputum culture in Columbia blood agar plate and chocolate agar plate was done and Staphylococcus intermedius was identified. The final diagnosis of this patient was pneumonia caused by Staphylococcus intermedius. Fleroxacin 0. 4 g per day was given by intravenous drip. Two weeks later, chest CT scan showed cuneate and flocculent shadow in the right upper lobe decreased obviously. Fuzzy shadow under the pleural the right lower lobe and pleural effusion on the right side of the chest disappeared. Four cases with Staphylococcus intermedius infection were reported and 3 were children. Two patients had open wound with infection. The involved organs included brain, joints, lungs, and one patient developed septicemia. Staphylococcus intermedius was identified from blood, sputum, cerebrospinal fluid, and pus from the open wound. By treatment with sensitive antibiotics three patients were cured but one patient with meningoencephalitis died of circulatory failure. Conclusions Staphylococcus intermedius infection can occur in many organs and its clinical manifestations are dependent on the infected location. Specimen culture for pathogen is necessary and blood, sputum, cerebrospinal fluid, and

关 键 词：中间型葡萄球菌 感染 鉴别诊断 

分 类 号：R446.5[医药卫生—诊断学]