误诊为结核且体内耐药的类鼻疽伯克霍尔德菌肺炎1例  

Multidrug-resistant Burkholderia pseudomallei pneumonia misdiagnosed as tuberculosis:A case report

作　　者：周钱辉 高燕 梁彦超 ZHOU Qianhui;GAO Yan;LIANG Yanchao(Department of Respiratory and Critical Care Medicine,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Zhuzhou Hunan 412007,China)

机构地区：[1]中南大学湘雅医学院附属株洲医院呼吸与危重症医学科,湖南株洲412007

出　　处：《中南大学学报(医学版)》2024年第9期1517-1522,共6页Journal of Central South University :Medical Science

基　　金：湖南省自然科学基金(2022JJ50105)。

摘　　要：类鼻疽伯克霍尔德菌是一种革兰氏阴性菌,沿海地区较多见,常因接触过病原菌污染的水源或土壤而感染。本文报告1例在外院误诊为肺结核,针对体外药敏试验结果用药耐药的慢性类鼻疽伯克霍尔德菌肺炎患者。患者为54岁男性,反复咳嗽,发现肺部结节1年余,口服抗感染药物症状可改善,但病情反复。2023年4月出现咳嗽加重、伴发热,肺部计算机断层扫描提示双肺多发结节,广谱抗生素治疗后肺部病灶部分进展,当地医院考虑结核可能。于中南大学湘雅医学院附属株洲医院进一步诊治,肺泡灌洗液及病变组织培养均提示类鼻疽伯克霍尔德菌阳性。依据药敏结果使用多西环素、阿莫西林克拉维酸钾等药物,但疗效欠佳,改用复方磺胺甲噁唑后疾病痊愈。该患者因直系家属有磺胺药物严重过敏史及自身耐药因素,在用药过程中经历多重波折。临床医师在处理相关情况时应警惕患者体内耐药可能。Burkholderia pseudomallei is a Gram-negative bacterium commonly found in coastal regions and is usually contracted through contact with contaminated water or soil.This report describes a case of chronic Burkholderia pseudomallei pneumonia in a 54-year-old male,initially misdiagnosed as pulmonary tuberculosis at an external hospital and resistance to treatment based on in vitro drug susceptibility testing.The patient experienced recurrent cough and pulmonary nodules for over 1 year,with symptoms temporarily alleviated by oral anti-infective drugs but recurring repeatedly.In April 2023,the patient presented with worsening cough and fever.A chest computed tomography(CT)scan revealed multiple bilateral lung nodules.Despite treatment with broad-spectrum antibiotics,the lung lesions progressed,leading to a presumptive diagnosis of tuberculosis at the local hospital.Further evaluation at Zhuzhou Hospital Affiliated to Xiangya School of Medicine confirmed Burkholderia pseudomallei through culture of bronchoalveolar lavage fluid and biopsy samples.Initial treatment based on drug susceptibility testing with doxycycline and amoxicillin-clavulanate showed poor efficacy.The regimen was switched to trimethoprim-sulfamethoxazole,resulting in a complete recovery.The patient faced significant treatment challenges due to a family history of severe sulfa drug allergy and personal drug resistance.This case underscores the importance of clinical vigilance regarding potential drug resistance in similar situations.

关 键 词：类鼻疽伯克霍尔德菌 肺炎 结核 误诊 耐药 

分 类 号：R563.1[医药卫生—呼吸系统]