非肺囊性纤维化患者社区获得性洋葱伯克霍尔德菌感染一例并文献复习  

Community-acquired Burkholderia cepacia infection in a non-cystic fibrosis patient:a case report and literature review

作　　者：毛雅云[1] 张宏英[1] 陈磊[1] 韩细妹 卞秀平 Mao Yayun;Zhang Hongying;Chen Lei;Han Ximei;Bian Xiuping(Department of Respiratory and Critical Care Medicine,Fuzhou Pulmonary Hospital of Fujian affiliated to Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属福建省福州肺科医院呼吸与危重症医学科,350001

出　　处：《国际呼吸杂志》2021年第3期196-201,共6页International Journal of Respiration

基　　金：福建省级临床重点专科建设项目(2018-145)。

摘　　要：目的:总结非肺囊性纤维化患者社区获得性肺洋葱伯克霍尔德菌感染的临床特征,以提高临床医师对本病的认识。方法:报道1例就诊于福建省福州肺科医院的社区获得性肺洋葱伯克霍尔德菌感染患者的诊治经过,并回顾1999-2020年国内外相关文献报道,筛选并总结分析临床资料。结果:患者为46岁男性,合并有尘肺。以反复发热为主要表现,血液检查呈急性化脓性炎性改变。经淋巴结穿刺培养出洋葱伯克霍尔德菌确诊本病。胸部CT示双肺多发结节影及纵隔淋巴结肿大。经过莫西沙星治疗,病情好转。结合相关文献和该病例,共20例患者,平均年龄50.7岁,以发热为主要表现,肺部及全身的多发脓肿为常见的病理改变,痰、脓液或支气管肺泡灌洗液培养阳性率高,对莫西沙星和头孢他啶治疗效果较好。结论:社区获得性非肺囊性纤维化患者的肺洋葱伯克霍尔德菌感染较为罕见。发病年龄较轻,与院内获得性感染相比,基础疾病或免疫抑制的比例较低。大多数起病较为凶险,如未及时诊断处理,病死率达到35.0%。患者年龄、肺部基础疾病、免疫状态、累及器官与该病预后无明显相关性,但合并急性呼吸窘迫综合征的患者病死率高达80.0%。Objective To summarize and analyze the clinical characteristics of community-acquired Burkholderia cepacia infection in non-cystic fibrosis patients,and to improve the clinicians′awareness of this disease.Methods The community-acquired Burkholderia cepacia infection in a non-cystic fibrosis patient in the Fuzhou Pulmonary Hospital of Fujian was reported.19 patients with this disease were searched in domestic and international literatures from 1999 to 2020.The clinical data were analyzed.Results The male patient with community-acquired Burkholderia cepacia infection was 46 years old.His basic disease was pneumoconiosis.He was hospitalized due to recurrent fever for more than ten days.Blood examination showed acute suppurative inflammation.Burkholderia cepacia was cultured by lymph node puncture to confirm the diagnosis.Chest CT showed multiple pulmonary nodules and mediastinal enlargement of lymph node.After moxifloxacin treatment,the patient improved and discharged from hospital.Combined with relevant literatures and this case,there were a total of 20 patients.The average age was 50.7 years old.Fever was the main manifestation,multiple abscesses in the whole body were common pathological changes.The positive rate of bacterial culture were high through spough,pus or bronchoalveolar lavage fluid.The effects of moxifloxacin and ceftazidime were better for this disease.Conclusions Community-acquired Burkholderia cepacia infection in non-cystic fibrosis individual is rare.These patients are younger.Compared with nosocomial infection,the proportion of these patients with basic diseases or immunosuppression history is lower,and the onset of most patients is more dangerous.If not diagnosed and treated in time,the mortality rate reaches 35.0%.The prognosis is not affected by the age,basic pulmonary disease,immune and the involvement of the organs.But the mortality of patients combined with acute respiratry distress syndrme is up to 80.0%.

关 键 词：洋葱伯克霍尔德菌 肺炎 脓肿 社区获得性感染 

分 类 号：R516[医药卫生—内科学]