类鼻疽伯克霍尔德菌致重症肺炎并发脓毒症死亡1例  

One death case of severe pneumonia complicated with sepsis induced by Burkholderia pseudomallei

作　　者：陈净 何昌华[2] 杨召伍[1] 陈山[1] 叶保旭 何林琳 CHEN Jing;HE Chang-hua;YANG Zhao-wu;CHEN Shan;YE Bao-xu;HE Lin-lin(People's Hospital of Wenchang City,Wenchang,Hainan 571300,China;不详)

机构地区：[1]海南省文昌市人民医院重症医学科,海南文昌571300 [2]海南省疾病预防控制中心,海南海口570203 [3]海南省文昌市人民医院药学部,海南文昌571300 [4]海南省文昌市人民医院检验科,海南文昌571300

出　　处：《中华医院感染学杂志》2023年第10期1495-1499,共5页Chinese Journal of Nosocomiology

基　　金：海南省自然科学基金项目(821MS150)。

摘　　要：目的通过对海南文昌地区1例因感染类鼻疽伯克霍尔德菌(BP)致重症肺炎并发脓毒症导致死亡的临床病例资料进行梳理分析,探讨感染类鼻疽的早期诊疗及预防重症策略。方法回顾性分析2022年9月文昌市人民医院收治的1例确诊为BP感染患者的临床资料,用描述性方法对患者的病情进展、实验室、影像学及诊疗资料分析总结,并查阅文献,对该病的流行病学特征、易感人群、临床表现和治疗进行探讨。结果该患者入院血糖31.4 mmol/L,后确诊为2型糖尿病;入院后反复发热,咳嗽、咳痰、呼吸困难,胸部影像学显示双肺感染实变呈进行性加重;外周血白细胞计数(WBC)、降钙素原(PCT)、超敏C-反应蛋白(CRP)均明显升高,血、痰培养均分离到BP;采取抗感染、呼吸机辅助通气、纤支镜肺泡灌洗、连续肾脏替代疗法(CRRT)+血液灌流等方案治疗,均未能控制病情迅速进展,伴发急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)、脓毒性休克,意识不清,符合BP致重症肺炎并脓毒血症的临床特征,在类鼻疽病临床分型中属于典型的急性败血症型,后因家属放弃治疗出院后死亡。结论文献显示BP在海南地区较常见,临床医生对出现不明原因的发热、咳嗽、气促等症状者,应高度警惕该病;相关标本培养出BP是诊断BP感染的金标准,积极送检培养,结合流行病史、实验室和影像学等资料,做到早发现、早诊断、早精准化治疗,以降低病死率;同时,本病案提醒对糖尿病患者并发BP感染时,应高度警惕疾病进展为重症肺炎和脓毒血症。OBJECTIVE To comb through the clinical data of one case of severe pneumonia complicated with sepsis induced by Burkholderia pseudomallei and explore the strategies for early diagnosis of melioidosis infection and prevention of severe illness.METHODS One case who was diagnosed with B.pseudomallei infection and was treated in the People′s Hospital of Wenchang City in Sep,2022 was enrolled in the study,the clinical data of the patient was retrospectively analyzed.The data of illness progression,laboratory test,imaging and treatment were analyzed and summarized by using descriptive method,relevant literatures were consulted,and the epidemiological characteristics,susceptible populations,clinical manifestations and treatment of the case were explored.RESULTS The blood glucose level of the patient was 31.4 mmol/L at the admission to the hospital,and the patient was then diagnosed with type 2 diabetes mellitus;the patient had recurrent fever,cough,expectoration and dyspnea.The chest imaging showed that the consolidation of double lung infection presented progressive exacerbation.The levels of peripheral blood white blood cell(WBC),procalcitonin(PCT)and high-sensitivity C-reactive protein(CRP)of the patient were remarkably elevated.B.pseudomallei was isolated from both blood and sputum specimens.The rapid progression of illness condition failed to be controlled after a series of treatment programs including anti-infection,assisted ventilation with ventilator,bronchoalveolar lavage and continuous renal replacement therapy(CRRT)plus hemoperfusion.The complication with acute respiratory distress syndrome(ARDS),multiple organ dysfunction syndrome(MODS),septic shock and disturbance of consciousness conformed to the clinical characteristics of severe pneumonia complicated with sepsis induced by B.pseudomallei.The case belonged to the typical acute sepsis among the clinical types of melioidosis and died after discharge due to the family′s abandoning treatment.CONCLUSION The epidemiological literature indicates that the B.ps

关 键 词：类鼻疽伯克霍尔德菌 类鼻疽病 重症肺炎 脓毒血症 治疗 预防 

分 类 号：R378[医药卫生—病原生物学]