慢性类鼻疽病1例报道及文献复习

A case report of chronic melioidosis and literature review

目的探讨类鼻疽病的早期诊断和治疗。方法回顾性分析2018年四川大学华西医院感染性疾病中心收治的1例慢性类鼻疽病例的流行病学、临床表现、辅助检查及诊治经过。结果患者有明确的类鼻疽伯克霍尔德菌流行区工作及生活史。主要临床表现为长期反复发热,胸腹部CT可见双肺、肝脏、脾脏多发结节形成。通过积极脾病理组织培养及二代高通量测序尽早确诊了类鼻疽伯克霍尔德菌感染。给予敏感药物治疗2周后好转出院。此后电话随访六月,未再出现相关不适症状。结论类鼻疽病为地区流行病,临床表现以急性感染为主,血液及肺为最常见感染部位。也有少数呈慢性感染且不易与结核、真菌、组织荚膜胞浆菌感染相鉴别。临床中若遇到长期反复发热伴有肝、脾多发结节的病人则应考虑该病的可能,以免误诊。

Objective To investigate the early diagnosis and treatment of chronic melioidosis. Methods The epidemiology, clinical manifestation, auxiliary examination, diagnosis and treatment of one case of chronic melioidosis admitted to Center of Infectious Diseases, West China Hospital, Sichuan University in 2018 were analyzed retrospectively. Results The patient had a clear work and life history in the epidemic area of Burkholderia pseudomallei. The main manifestation were long-term recurrent fever, chest and abdominal CT showed nodules in bilateral lungs, liver and spleen. Early diagnosis of melioidosis was confirmed by positive splenic pathological tissue culture and next generation sequencing. After treatment with sensitive medicine for 2 weeks, the patient was discharged from the hospital. And there were no related symptoms after telephone follow-up for 6 months. Conclusion Melioidosis is a regional epidemic disease. Acute infections are common, and the majority infection sites are blood and lung. There are also a few cases of chronic infection were reported, which are not easy to distinguish from infections by tuberculosis, fungi and Histoplasma capsulatum. In clinical practice, if the patients with long-term recurrent fever and multiple nodules of liver and spleen, they should be considered the possibility of chronic melioidosis. We should avoid the misdiagnosing this disease.