海分枝杆菌引起骨髓增生异常综合征患者血流感染一例

A case of bloodstream infection caused by Mycobacterium marinum in a patient with myelodysplastic syndrome

海分枝杆菌属于光产色缓慢生长型非结核分枝杆菌的一种,该文报告1例由海分枝杆菌引起血流感染的骨髓增生异常综合征患者,其因面色苍白乏力20余年、意识模糊1 d入院。患者于20年前被诊断为再生障碍性贫血,入院前半年被诊断为骨髓增生异常综合征,入院后通过全自动血培养仪对其静脉血标本进行需氧和厌氧培养,分离阳性培养物,经革兰染色及抗酸染色后,再进一步使用质谱分析技术进行鉴定,最后明确为海分枝杆菌感染。积极给予患者抗感染、调节免疫以及其它对症治疗后仍无效,其因呼吸、心力衰竭而死亡。海分枝杆菌为革兰阳性杆菌,抗酸染色阳性,常规方法无法鉴定,因此对于血培养分离到的细菌,除了采用革兰染色及常规方法鉴定外,还需结合抗酸染色以及质谱分析技术,以便为不常见细菌的鉴定提供可靠依据。

Mycobacterium marinum is a type of slow-growing photochromogenic nontuberculous mycobacteria.Here,we reported one case of myelodysplastic syndrome presenting with bloodstream infection induced by Mycobacterium marinum.The patient was admitted to our hospital due to pale face and fatigue for over20years and unconsciousness for1d.The patient was diagnosed with aplastic anemia20years ago,and diagnosed with myelodysplastic syndrome at6months prior to admission.After admission,the venous blood samples were collected and cultured in aerobic and anaerobic conditions by automatic blood culture instrument.Then,the positive cultures were isolated.After Gram s staining and anti-acid staining,the quality spectrum technique was used for identification.The diagnosis of Mycobacterium marinum infection was validated.The patient died from respiratory failure and heart failure after anti-infection intervention,immune therapy and alternative treatment.Mycobacterium marinum was gram-positive bacilli and positive for anti-acid staining,which could not be identified by conventional methods.Besides Gram s staining and conventional methods,anti-acid staining and mass spectrum analysis should be performed to provide reliable evidence for the identification of uncommon bacteria.