类鼻疽伯克霍尔德菌致感染性动脉瘤3例并文献复习

Infectious aneurysm due to Burkholderia pseudomallei: three case report and literature review

目的总结类鼻疽伯克霍尔德菌致感染性动脉瘤的临床特征,为该病的诊治提供依据,以期减少误诊率和病死率。方法收集2013年1月—2017年12月海南省人民医院确诊的类鼻疽伯克霍尔德菌致感染性动脉瘤病例3例,同时检索自1990—2017年国内外类鼻疽伯克霍尔德菌致感染性动脉瘤患者的病例报道,回顾性分析以上所有病例的临床特点。结果共纳入23例患者,其中男性患者占95. 7%,平均发病年龄(62. 2±5. 8)岁,主要伴随疾病是高血压和糖尿病,均占39. 1%,动脉瘤主要病变节段是腹主动脉(65. 2%),其次是胸主动脉(17. 4%)和主动脉弓(13. 0%),21例患者(91. 3%)接受手术治疗,病死率21. 7%。结论类鼻疽伯克霍尔德菌致感染性动脉瘤病死率较高,患有高血压和糖尿病的中老年男性为其高危人群,主要病变节段为腹主动脉。早期经验性抗感染治疗应注意覆盖该菌,一旦确诊后应在积极抗感染的基础上手术治疗。

Objective To summarize the clinical characteristics of infectious aneurysms caused by Burkholderia pseudomallei(B.pseudomallei),provide evidence for the diagnosis and treatment of the disease,and reduce the misdiagnosis rate and mortality.Methods Three cases of infectious aneurysms caused by B.pseudomallei and confirmed in Hainan General Hospital from January 2013 to December 2017 were collected,case reports of infectious aneurysms caused by B.pseudomallei at home and abroad from 1990 to 2017 were retrieved,clinical characteristics of all above cases were retrospectively analyzed.Results A total of 23 patients were enrolled,male patients accounted for 95.7%,with an average age of(62.2±5.8)years,hypertension and diabetes were the main complications,both accounting for 39.1%,abdominal aorta(65.2%)was the main lesion segment of aneurysm,followed by thoracic aorta(17.4%)and aortic arch(13.0%),21 patients(91.3%)underwent surgical treatment,with a mortality of 21.7%.Conclusion Mortality of infectious aneurysms caused by B.pseudomallei is high,middle-aged and elderly men with hypertension and diabetes are at high risk,the main lesion segment is abdominal aorta.Early empiric anti-infective treatment should be paid attention to B.pseudomallei,once diagnosed,surgical treatment should be performed on the basis of active anti-infective treatment.