李斯特菌病患者的临床特征

Clinical characteristics of patients with listeriosis

目的:探讨李斯特菌病的临床特点,为李斯特菌病的诊断、治疗及医院感染防控提供依据。方法:回顾性分析2013年1月至2019年6月10入住中南大学湘雅医院的10例李斯特菌病感染患者,收集并分析其年龄、性别、基础情况、病例类型、临床表现、首诊科室、发病至确诊天数、感染指标、标本检出类型、药敏试验结果、治疗情况、是否医院内感染、转归的资料及随访结果。结果:在10例李斯特菌病患者中,妊娠相关病例2例,成人非妊娠相关病例8例,其中3例为医院感染。患者发病年龄为27~71岁,发病至确诊的间隔时间为5~36 d。5例发热,5例无发热;10例患者均有头痛、乏力、局部疼痛及其他专科症状;大部分李斯特菌病患者血常规检查中白细胞数、中性粒细胞比值、C反应蛋白、降钙素原均升高,红细胞沉降率加快。所有患者均对氨苄西林、青霉素G、美洛培南、复方新诺明敏感。结论:李斯特菌病多累及免疫力低下者,临床易误诊、漏诊;早预防、早诊断、早治疗可降低病死率;医院感染管理部门需重视患者饮食管理,防止医院出现李斯特菌病的感染和暴发。

Objective:To investigate the clinical characteristics of patients with listeriosis and to provide a basis for diagnosis,treatment,prevention and control of hospital infection.Methods:A total of 10 inpatients,who suffered from the listeriosis in Xiangya Hospital,Central South University from January 2013 to June 2019,were retrospectively collected for this study.The characteristics of the patients’age,gander,basic information,case type,clinical manifestations,first consultation department,days of diagnosis,infection indicator,specimen type,results of drug sensitivity,treatment plan,hospital infection or not,outcome,follow-up data were analyzed.Results:Two cases were pregnant women and other were non-pregnant adults among 10 patients with listeriosis.Among them,there were 3 cases with hospital acquired infection.The age of patient onset was 27-71 years old,and the time from onset to diagnosis was 5-36 days.Five cases had fever,and other 5 cases had not fever.There were headache,fatigue,local pain,and other specialized symptoms in the 10 patients.The white blood cell count,the neutrophil ratio,the inflammatory index C-reactive protein,the procalcitonin were all increased,and the erythrocyte sedimentation was accelerated in the 10 patients.All the patients were sensitive to ampicillin,penicillin G,meropenem,and compound sinomine.Conclusion:Listeriosis often affects the patients with low immunity,which often leads to misdiagnosis or missed diagnosis in clinic.So early prevention,early diagnosis,and early treatment can reduce mortality;it is important for departments of nosocomial infection management to manage patients’diet for avoiding outbreaks of listeriosis in hospital.