暴发性鹦鹉热合并多器官功能衰竭综合征一例报告  

Fulminant psittacosis complicated with multiple organ dysfunction syndrome:a case report

作　　者：钱雪琴 王轶[1] 张慧涛[1] 申德志 黄楷壮 朱瑶丽[1] Qian Xueqin;Wang Yi;Zhang Huitao;Shen Dezhi;Huang Kaizhuang;Zhu Yaoli(Department of Critical Care Unit,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院重症医学科,珠海519000

出　　处：《新医学》2023年第9期691-694,共4页Journal of New Medicine

摘　　要：暴发性鹦鹉热合并MODS病例较罕见,国内文献鲜有报道。该文总结了一例暴发性鹦鹉热合并MODS患者的临床表现及治疗过程。患者为80岁老年男性,急诊即出现呼吸衰竭加重,予机械通气,并快速进展为ARDS并伴有意识障碍及MODS,在BALF mNGS结果回报为鹦鹉热衣原体后先后使用莫西沙星、多西环素及奥马环素治疗,取得良好效果,患者预后良好。该例患者的诊治过程提示,暴发性鹦鹉热可表现为呼吸衰竭、重症肺炎伴快速进展并出现MODS,影像学主要表现为肺炎、支气管充气征、胸腔积液;宏基因组二代测序(mNGS)技术可以及早发现罕见病原体,明确诊断。治疗上可选择四环素类、大环内酯类和喹诺酮类药物作为抗菌药物治疗。The cases of fulminant psittacosis complicated with multiple organ dysfunction syndrome(MODS)have been rarely reported in China.In this article,clinical manifestations and treatment of a patient with fulminant psittacosis complicated with MODS were summarized and analyzed.The 80-year-old male patient developed respiratory failure in Emergency Department and received mechanical ventilation,which rapidly progressed into acute respiratory distress syndrome(ARDS)complicated with MODS.Metagenomic next-generation sequencing(mNGS)using bronchoalveolar lavage fluid(BALF)samples confirmed the pathogen of Chlamydia psittaci.Then,moxifloxacin,doxycycline and omadacycline were given,which yielded favorable efficacy and prognosis.The diagnosis and treatment of this patient suggests that fulminant psittacosis can be manifested with respiratory failure,severe pneumonia with rapid progression and MODS.Imaging manifestations consist of pneumonia,bronchial inflation sign and pleural effusion.mNGS can be performed to identify the rare pathogens during early stage and confirm the diagnosis.Tetracyclines,macrolides and quinolones can be delivered as antibacterial drugs.

关 键 词：鹦鹉热衣原体 多器官功能衰竭综合征 宏基因组二代测序 重症肺炎 

分 类 号：R518.1[医药卫生—内科学] R459.7[医药卫生—临床医学]