类鼻疽骨髓炎3例并文献复习

Report of three cases of osteomyelitis caused by Burkholderia pseudomallei and literature review

目的分析类鼻疽骨髓炎的临床特点、诊断和治疗。方法对中南大学湘雅医学院附属海口医院2007年4月-2017年4月收治的3例类鼻疽骨髓炎进行回顾性分析,并总结分析同期国内外文献报道的12例类鼻疽骨髓炎患者资料。结果临床多表现为发热及感染部位的红、肿、热、痛等。病变好发于胫骨、股骨和颅骨,且病灶常多发,合并的感染病灶中以脾、软组织、关节最为常见,影像学主要表现为骨髓炎,所有患者均经细菌培养得到确诊,强化治疗阶段以"头孢他啶、甲氧苄啶-磺胺甲唑、碳青霉烯类"抗感染及外科手术为主,病原菌清除治疗阶段以"甲氧苄啶-磺胺甲唑、多西环素"抗感染为主,两个阶段治疗周期均长,规范治疗后复发率低。结论类鼻疽骨髓炎临床表现缺乏特异性,影像学提供定位诊断,细菌培养是确诊标准,及时有效的外科干预和抗菌药物治疗可降低死亡率;全程的、规范的抗感染治疗可减少复发。

Objective To describe the clinical features, diagnosis and treatment of osteomyelitis caused by Burkholderia pseudomallei. Methods Three cases of osteomyelitis caused by B. pseudomallei were treated in Haikou People＇s Hospital affiliated to Xiangya Medical College of Central South University from April 2007 to April 2017. The clinical data were reviewed and analyzed retrospectively. Relevant reports of osteomyelitis due to B. pseudomallei in China and abroad from 2007 to 2017 were comprehensively reviewed. Results The clinical manifestations included hot feeling, redness, swelling, and pain at site of infection. The infection usually occurred in tibia, femur, and skull bone. There were usually multiple lesions, frequently involving spleen, soft tissue and joints. The main imaging finding was osteomyelitis. The diagnosis was confirmed by bacterial culture in all patients. Antimicrobial therapy combined with surgical intervention was the most common approach in the stage of intensive treatment. Ceftazidime, trimethoprimsulfamethoxazole and carbapenems were the mostly used antibiotics. However, in the stage of bacterial eradication, trimethoprimsulfamethoxazole and doxycycline were used. The duration of treatment was very long in both stages. The recurrence was low after standard treatment. Conclusions The osteomyelitis caused by B. pseudomallei lacks specific clinical manifestation. Imaging techniques can identify the site of infection, and bacterial culture helps confirm the diagnosis. Timely and effective antimicrobial therapy combined with surgical intervention can reduce mortality. Full course and standard anti-infective therapy may prevent recurrence.