艾滋病合并沙门菌血流感染临床特点、病原特征和预后分析

Clinical characteristics,pathogenic features and prognosis of AIDS patients complicated with Salmonella bloodstream infection

目的探讨艾滋病(acquired immune deficiency syndrome,AIDS)合并沙门菌血流感染的临床特点、病原特征和预后,为提高其诊治水平提供依据。方法分析广州市第八人民医院2009年1月至2018年4月期间,所收治的AIDS合并沙门菌血流感染患者的临床表现、实验室炎症指标、沙门菌血清型、药物敏感性以及预后。结果10年期间共收治2 405例AIDS合并血流感染患者,病原鉴定为革兰阴性杆菌191例(7.9%),其中82例(42.9%)鉴定为沙门菌。82例AIDS合并沙门菌血流感染患者,男65例,女17例,平均年龄(37.1±12.5)岁。诊断为AIDS C3期79例(96.3%),B2期3例(3.7%)。其中合并肺部感染38例,播散性马尔尼菲篮状菌病16例,肺孢子菌肺炎15例,结核病12例,巨细胞病毒(CMV)感染10例,播散性隐球菌病4例。所有患者(100%)均发热,其他主要临床症状包括:畏寒72例(87.8%),寒战48例(58.5%),咳嗽、咳痰35例(42.7%),皮疹15例(18.3%),仅4例(4.9%)出现腹泻、腹痛、脓血黏液便等胃肠道症状。CD4+T淋巴细胞均数为9个/μL。实验室炎症指标:白细胞升高4例(4.9%),降低35例(42.7%);所有患者的降钙素原和C反应蛋白均升高。沙门菌血清分型:肠炎沙门菌55株(67.0%),猪霍乱沙门菌12株(14.6%),鼠伤寒沙门菌7株(8.5%),其他8株(9.8%)。药物敏感性:氨苄西林耐药64.6%,复方新诺明、氯霉素和头孢他啶耐药率分别为22.0%、23.2%和4.9%。82例AIDS合并沙门菌血流感染患者好转或治愈55例(67.1%),恶化或死亡27例(32.9%)。结论AIDS合并沙门菌血流感染经常无明显消化道症状,血清分型以肠炎沙门菌为主,耐药率和病死率高,需尽早诊断和针对性治疗。

Objective To investigate the clinical characteristics,pathogenic features and prognosis of AIDS patients complicated with Salmonella bloodstream infection.Methods The clinical manifestations,laboratory inflammatory indicators,salmonella serotypes,drug susceptibility and prognosis were analyzed for the AIDS patients complicated with Salmonella bloodstream infection admitted to Guangzhou Eighth People′s Hospital from January 2009 to April 2018.Results A total of 2 405 AIDS patients with blood stream infection were admitted to hospital during the last 10 years.191 cases(7.9%)were identified to have Gram-negative bacilli infection.Among them,82 cases(42.9%,65 male and 17 female)with Salmonella bloodstream infection and the average age is 37.1.79 cases(96.3%)were classified into the stage of AIDS(C3)and 3(3.7%)were the stage of AIDS(B2).There were 38 cases complicated with pulmonary infection,16 cases with disseminated talaromycosis marneffei,15 cases with pneumocystis pneumonia,12 cases with tuberculosis,10 cases with cytomegalovirus(CMV)infection and 4 cases with disseminated cryptococcosis.All patients presented with fever(100%).Other main clinical manifestations contained chills(87.8%),shivering(58.5%),cough and expectoration(42.7%),and rash (18.3%).However,only 4 cases(4.9%)developed gastrointestinal symptoms such as diarrhea,abdominal pain,and bloody purulent stool.Mean values for CD4^+ T lymphocytes were 9 cells/μL.For the inflammation indicators,white blood cell(WBC)was increased in 4 cases(4.9%),decreased in 35 cases(42.7%);all patients had elevated procalcitonin(PCT)and C-reactive protein(CRP).Salmonella serotypes:55 strains of Salmonella enteritidis(67.0%),12 strains of Salmonella choleraesuis(14.6%),7 strains of Salmonella typhimurium(8.5%),and 8 strains (9.8%) unclassified.Drug sensitivity test showed that 64.6% strains were resistant to ampicillin,22.0% resistant to compound sulfamethoxazole,23.2% resistant to chloramphenicol and 4.9% resistant to ceftazidime.Among 82 cases,55(67.1%)achieved improvement or cure and 27 patients(32.9%)deteriorated or died.Conclusions AIDS patients complicated with Salmonella bloodstream infection seldom manifest obvious gastrointestinal symptoms.Salmonella enteritidis is the main serotype.The drug resistance rate and mortality rate are high;therefore,it is necessary to make early diagnosis and targeted treatment.