儿童肝片形吸虫合并铜绿假单胞菌感染1例  

A case of Fasciola hepatica infection combined with Pseudomonas aeruginosa in a child

作　　者：柏厚熹 杨小涛[1] 罗永涵 王艳春[1] BAI Houxi;YANG Xiaotao;LUO Yonghan;WANG Yanchun(The 2nd Department of Infectious Disease,Kunming Children’s Hospital,Kunming 650000,Yunnan,China)

机构地区：[1]昆明市儿童医院感染二科,云南昆明650000

出　　处：《中国寄生虫学与寄生虫病杂志》2024年第4期550-553,共4页Chinese Journal of Parasitology and Parasitic Diseases

摘　　要：患儿,男,13岁,云南临沧云县人,2023年10月20日因“发热、右上腹疼痛2天余”至当地市人民医院就诊,腹部CT平扫示肝内多发斑片状稍低强化,考虑感染性病变,予头孢曲松等(剂量疗程不详)抗感染、吡喹酮驱虫治疗无好转。11月9日转至昆明市儿童医院住院治疗。入院查体:剑下稍隆起,右上腹压痛,右侧腹直肌外缘可触及约3 cm×2.5 cm的包块,肝于右肋下4 cm,剑下5 cm可及。血常规检查示嗜酸粒细胞计数升高(1.02×10^(9)/L)、C反应蛋白升高(68.54 mg/L)。血生化检测示丙氨酸转氨酶(90 U/L)、天冬氨酸转氨酶(51 U/L)、γ‑谷氨酰转移酶(296 U/L)、碱性磷酸酶(794 U/L)、免疫球蛋白G(34.55 g/L)升高,血沉加快(67 mm/h),血培养阴性,粪样镜检未查见虫卵。腹部CT平扫+增强示肝实质内多发低密度灶,肝内胆管扩张并胆管炎可能。酶联免疫吸附试验(ELISA)检测示血清片形吸虫抗体阳性。静脉血宏基因组二代测序,检出肝片形吸虫序列5条、铜绿假单胞菌序列8条,未检出真菌、病毒等其他病原体序列。患者居住于农村,有食用凉拌水芹菜和饮生水史。结合患者流行病学调查、体格检查及相关辅助检验结果,最终诊断为肝片形吸虫合并铜绿假单胞菌感染,予三氯苯达唑(500 mg/d,每天1次)口服2 d,美罗培南[60 mg/(kg•d),每天3次]抗感染治疗2周后,未再发热、腹痛,好转出院。出院后3个月随访、复查,未再触及腹部包块,血常规检测示嗜酸粒细胞计数正常,腹部CT平扫示大部分病灶较前减小。The patient was a 13‑year‑old male from Yun County,Lincang City,Yunnan province.He went to the local city hospital on October 20,2023,for treatment due to“Fever with right upper abdominal pain for over 2 days”.The abdominal CT showed uneven enhancement of the liver parenchyma with multiple patches of slight hypoen‑hancement,suggesting an infectious lesion.He was given ceftriaxone with other anti‑infection treatments(dosage course of treatment was unknown)and praziquantel against helminth infections,but the symptoms did not improve.He was transferred to Kunming Children’s Hospital on November 9 for inpatient treatment.The physical examination showed a slight bulge below the xiphoid,pressure pain in the right epigastric region,a mass about 3 cm×2.5 cm in size pal‑pable at the outer edge of the rectus abdominis muscle on the right side,and the liver palpable 4 cm below the right costal margin and 5 cm below the xiphoid.Routine blood tests showed an elevated eosinophil count(1.02×10^(9)/L)and elevated C‑reactive protein(CRP)(68.54 mg/L).The other blood tests showed elevated alanine aminotransferase(90 U/L),aspartate aminotransferase(51 U/L),γ‑glutamyltransferase(296 U/L),alkaline phosphatase(794 U/L),and immu‑noglobulin G(34.55 g/L),with accelerated sedimentation rate(67 mm/h).The blood cultures were negative.No eggs were found in stool under microscopy.Abdominal CT scan and enhancement showed multiple hypodense foci in the liver parenchyma,intrahepatic bile duct dilatation and possible cholangitis.The result of enzyme‑linked immunosorbent assays for serum antibody against Fasciola hepatica was positive.Five sequences of F.hepatica and eight sequences of Pseudomonas aeruginosa were detected in the venous blood by metagenominext‑generation sequencing,and no sequences of other pathogens were detected,such as fungi and viruses.The patient lived in a rural area and had a history of consuming cold watercress and drinking unboiled water.Epidemiological investigation,physical examina‑tion and

关 键 词：肝片形吸虫 铜绿假单胞菌 宏基因组二代测序 儿童 

分 类 号：R532.29[医药卫生—内科学]