发热伴血小板减少综合征伴空肠弯曲菌菌血症1例  

A case of severe fever with thrombocytopenia syndrome with Campylobacter jejuni bacteremia

作　　者：邵淑丽[1] 张瑜 马淑青[1] SHAO Shu-li;ZHANG Yu;MA Shu-qing(Central Laboratory,Weihai Municipal Hospital,Weihai,Shandong 264200,China;College of Laboratory Medicine,Dalian Medical University,Dalian,Liaoning 116000,China)

机构地区：[1]威海市立医院中心实验室,山东威海264200 [2]大连医科大学检验医学院,辽宁大连116000

出　　处：《中国热带医学》2023年第4期439-442,共4页China Tropical Medicine

摘　　要：目的本文通过分析发热伴血小板减少综合征(severe fever with thrombocytopenia syndrome,SFTS)伴空肠弯曲菌引起菌血症的1例罕见病例,提高临床对血培养的重视,为疾病诊疗提供经验。方法收集整理威海市立医院收治的1例SFTS继发空肠弯曲菌感染引起的菌血症的临床资料,对病原菌的诊断过程以及治疗方案进行回顾性分析。结果患者女性,半月前被蜱虫叮咬,因“发热、脐周腹部隐痛、腹泻5 d”于2022年8月30日来院就诊。辅助检查示白细胞、血小板减少,新型布尼亚病毒核酸检测阳性,诊断为SFTS。抗病毒以及对症治疗1周后,患者夜间突发高热,体温最高达39.5℃,抽取双侧双瓶血培养。双侧厌氧瓶于53.06 h报阳,转种血平板厌氧培养出革兰氏阴性弯曲菌,经质谱MALDI-TOF MS鉴定为空肠弯曲菌。根据细菌病原学停用万古霉素,改用美罗培南抗感染。治疗期间,血培养以及新型布尼亚病毒核酸检测转阴,患者症状缓解,复查各项指标结果为正常后出院。结论本病例提示空肠弯曲菌不仅引起肠道内感染,也可在免疫力低下人群中引起肠外感染。提高临床以及实验室人员对空肠弯曲菌的认识,重视血培养并应用多学科联合进行诊断治疗。Objective This article aims to present a rare case of severe fever with thrombocytopenia syndrome(SFTS)complicated by with bacteraemia caused by Campylobacter jejuni,and to discuss the pathogenic characteristics,culture methods,clinical features and treatment points of Campylobacter jejuni and the patient's outcome,with a view to raising clinical awareness of blood culture and providing experience for the treatment of this disease.Methods The clinical data of a case with SFTS complicated by bacteremia caused by Campylobacter jejuni admitted to Weihai Municipal Hospital were collected and the diagnostic process of the pathogenic bacteria as well as the treatment plan were retrospectively analysed.Results The patient was a female who had been bitten by a tick bite half a month ago and presented to the hospital on 30th August with a fever,vague pain in the peribulbar abdomen and diarrhea for 5 days.Laboratory tests showed leukopenia and thrombocytopenia,and nucleic acid detection for SFTS was positive,resulting in a diagnosis of SFTS.After a week of antiviral treatment with ribavirin and symptomatic treatment,the patient suddenly experienced high fever at night,with a temperature reaching 39.5℃.Blood cultures were immediately taken from both sides of the double bottle.Bilateral anaerobic bottles were tested for positive after 53.06 hours,and Gram-negative Campylobacter was cultured anaerobically in a transfer blood plate and further identified as Campylobacter jejuni using mass spectrometry MALDI-TOF MS.Vancomycin was stopped clinically on the basis of bacterial pathogenesis and meropenem was used for anti-infection and symptomatic treatment.During the treatment,blood culture and nucleic acid detection for SFTS turned negative,and the patient's symptoms improved.After normal results were achieved in the follow-up testing,the patient was discharged.Conclusions This case serves as a reminder that Campylobacter jejuni not only causes intestinal infections,but can also lead to extra-intestinal infections in immunocomp

关 键 词：蜱叮咬 发热伴血小板减少综合征 空肠弯曲菌 菌血症 

分 类 号：R446.5[医药卫生—诊断学]