结肠小袋纤毛虫感染1例  

A case of Balantidium coli infection

作　　者：王登辉 张艳 聂蔷 刘红威 WANG Denghui;ZHANG Yan;NIE Qiang;LIU Hongwei(Yongcheng Central Hospital,Yongcheng 476600,Henan,China;Zhengzhou Adicon Medical Laboratory,Zhengzhou 450000,Henan,China)

机构地区：[1]永城市中心医院,河南永城476600 [2]郑州艾迪康医学检验所,河南郑州450000

出　　处：《中国寄生虫学与寄生虫病杂志》2023年第5期647-649,共3页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：患者,男,87岁,农民,河南永城人。患者自述于2023年6月25日无明显诱因出现纳差、食欲下降,伴有腹泻(4~5次/d)和低热(体温37.5℃)。就诊于当地社区医院,未予详细检查,输液(具体药物不详)治疗后无好转,于7月5日转诊至河南省永城市中心医院。患者长期务农,家中饲养猫、犬等动物,无猪饲养史及密切接触史,无猪粪施肥,无饮用生水史。入院查体:体型消瘦,心肺听诊无明显异常,腹部平软,未见胃肠型及蠕动波,未见腹部静脉曲张,肝脾肋下未触及,下腹部有压痛,其余部位无压痛及反跳痛,移动性浊音阴性,肠鸣音活跃,未闻及气过水声。血常规示:白细胞计数11.9×10^(9)/L,红细胞计数4.11×10^(12)/L,血小板计数358×10^(9)/L,血红蛋白119 g/L,血钾3.13 mmol/L,肝功能白蛋白32.5 g/L。粪常规示:墨绿色稀便,隐血试验阳性,未见红细胞、白细胞,未检出寄生虫或虫卵,粪样培养无异常。行全腹部CT平扫+增强,示胆囊体积增大,肝门区胆管、胆总管及胰管稍扩张,胃底近贲门处胃壁稍增厚,直肠、乙状结肠肠壁弥漫性增厚、水肿。予以补液、维持水电解质平衡、纠正电解质紊乱治疗,同时口服小檗碱片(每次0.1 g,3次/d)、蒙脱石散(每次3 g,3次/d)、双歧杆菌(每次1 g,3次/d,与蒙脱石散间隔2 h服用),患者排便次数逐渐减少,逐渐转为黄色软便。7月11、12日粪样经显微镜下观察,均检测到疑似结肠小袋纤毛虫包囊,经永城市疾病预防控制中心会诊确认为结肠小袋纤毛虫包囊。调整为口服小檗碱(每次0.1 g,3次/d)和甲硝唑片(每次0.2 g,2次/d),继续予营养支持治疗。7月13日,患者排便已转为每日1次,黄色软便,镜检未见寄生虫。7月18日,患者经综合治疗后痊愈出院,随访观察显示预后良好。The patient was an 87⁃year⁃old male farmer from Yongcheng,Henan.He reported having nausea and decreased appetite without obvious causes on June 25th,2023,accompanied by diarrhea(4-5 times/d)and low⁃grade fever(body temperature of 37.5℃).He was treated at a local community hospital without detailed examinations and showed no improvement after receiving infusions of unknown drugs.Due to a referral,he was admitted to the Yongcheng Central Hospital on July 5th.The patient has been undertaking farming for a long time,and animals such as cats and dogs are bred in his home.He has no history of breeding pigs or close contact,no history of applying pig manure,and no history of drinking unboiled water.On admission,physical examination showed a thin body type,no apparent abnormalities in heart and lung auscultation,a soft and flat abdomen,no gastrointestinal waves or peristal⁃sis,no varicose veins in the abdomen,no liver or spleen felt under the ribs,tenderness in the lower abdomen,no tenderness or rebound tenderness in other parts,negative mobile cloudy urine,active bowel sounds,and no audible gas⁃water sound.The blood routine test showed a white blood cell count of 11.9×10^(9)/L,a red blood cell count of 4.11×10^(12)/L,a platelet count of 358×10^(9)/L,a hemoglobin of 119 g/L,a blood potassium of 3.13 mmol/L,and an albumin of 32.5 g/L in the liver function test.The stool routine test showed a dark green loose stool,a positive occult blood test,no red blood cells or white blood cells,no parasitic eggs detected,and no abnormalities in the fecal culture.A plain and enhancement scan of the entire abdomen was performed,which showed an increased volume of the gallblad⁃der,slightly dilated bile ducts,common bile duct,and pancreatic duct in the hepatic portal area,slightly thickened gastric wall near the cardia,and diffuse thickening and edema of the intestinal walls in the rectum and sigmoid co⁃lon.The patient was treated for rehydration and correction of electrolyte imbalance.Simultaneously,oral berberine tab�

关 键 词：结肠小袋纤毛虫 诊断 治疗过程 

分 类 号：R382.4[医药卫生—医学寄生虫学]