香味类香味菌尿路感染合并膀胱重度挛缩的诊治并文献复习

Diagnosis and treatment of urinary tract infection due to Myroides odoratimimus combined with bladder contracture and literature review

目的:探讨香味类香味菌尿路感染合并膀胱重度挛缩的临床、病理特点和诊断、治疗方法。方法:回顾性分析1例香味类香味菌尿路感染合并膀胱重度挛缩患者的临床、病理和实验室检查资料并复习相关文献。患者,男,38岁,因"尿频尿急肉眼血尿1个月余入院",行生化及免疫学检查、彩超、CT、膀胱镜、尿培养、活检组织病理检查、活检物镜检等检查,并给予对症治疗、膀胱水扩张、膀胱黏膜保护剂灌注、抗感染治疗等综合治疗,3个月后随访复查。结果:CT提示膀胱重度挛缩,膀胱壁显著增厚;经尿道膀胱镜检查发现膀胱容量显著减小,膀胱黏膜弥漫呈"白石灰"样改变;显微镜微生物检查发现香味类香味菌活菌体,连续尿培养7次结果均提示:香味类香味菌,并多重耐药。给予综合治疗后,患者临床症状明显好转,膀胱容量接近正常,尿培养结果正常,CT及膀胱镜复查明显好转。结论:膀胱挛缩患者的病因复杂,明确诊断困难,尿培养、膀胱镜结合病理检查可提高诊断率;香味类香味菌感染临床罕见,合并膀胱重度挛缩未见报道,综合治疗可能会收到满意疗效。

Objective：To investigate the clinical and pathological characteristics,diagnosis and treatment of Myroides odoratimimus infection combined with bladder contracture.Method：The clinical,pathological and laboratory data of a case of Myroides odoratimimus urinary tract infection combined with severe contracture of the bladder were retrospectively analyzed and the related literature was reviewed.The male patient whose age was 38 years old was admitted to hospital becuase of urinary frequency,urgency and gross hematuria for more than one month.Laboratory examination,ultrasound,CT,cystoscopy,urine culture and biopsy were preformed.Bladder water expansion,bladder mucosal protective agent perfusion,anti-infective treatment and other comprehensive treatment were applied.The patient were followed up for three mouths after discharging.Result：CT showed severe contracture of bladder and significant thickening of bladder.Transurethral cystoscopy showed a significant reduction of bladder capacity and a ＂ white lime＂-like change in the bladder mucosa.The results of seven-time urine culture were all multiple drug resistance Myroides odoratimimus.After treatment,the clinical symptoms improved significantly,the bladder volume returned to normal,urine culture results were normal,CT and cystoscopy review improved significantly.Conclusion：Urinary culture and cystoscopy combined with pathologic examination can improve the diagnosis rate of patients with bladder contracture.The urinary tract infection of Myroides odoratimimus is rare.Severe contracture of bladder combined with Myroides odoratimimus infection has never been reported.The comprehensive treatment may obtain satisfactory results.