一例重症腺型鼠疫患者临床特征分析

Clinical characteristics of a severe bubionic plague patient

目的了解重症腺型鼠疫临床表现及预后情况,探讨重症腺型鼠疫病例救治经验。方法对2019年11月11日化德县收治的1例重症腺型鼠疫患者的临床资料、救治经过进行回顾分析。结果该患者为55岁男性,于鼠疫疫源地捕食野兔后发病;临床表现为发热,乏力,左侧腋下皮肤硬、肿、热、痛,后期淋巴结肿大明显,呃逆及胸腔积液;实验室检查显示弥散性血管内凝血(DIC)、脓毒症、多脏器功能障碍;入院第3天经鼠疫菌培养、鼠疫噬菌体裂解试验阳性确诊为腺型鼠疫。确诊后给予血小板、血浆、液体复苏、链霉素联合莫西沙星等治疗后,纠正DIC,多脏器功能恢复正常,硬肿消退;疗程共19 d,体温恢复正常并达到痊愈。结论本例患者是以淋巴管炎、皮肤硬肿、凝血异常为主要表现的重症腺型鼠疫病例;及时识别、评估以及早期、联合治疗是救治成功的关键。

Objective:To understand the clinical manifestations and prognosis of severe bubonic plague,and to explore the treatment experience of severe bubonic plague.Methods:A retrospective analysis was conducted on the clinical data and treatment of a case of severe bubonic plague admitted to Huade County on November 11,2019.Results:The case of bubonic plague was a 55-year-old male,and outbreak after hunting the hare at the foci.The clinical manifestations included fever,fatigue,left armpit skin hard,swelling,heat and pain,distinctness of lymph node enlargement in later stage,hiccups and pleural effusion.Laboratory tests showed diffuse intravascular coagulation(DIC),sepsis and multiple organ dysfunctions.Bubonic plague was confirmed by positive culture of Yersinia pestis and positive phage lysis test on the 3rd day after admission.After platelet,plasma,fluid resuscitation and streptomycin combined with moxixacin,DIC and multiple organ functions were restored to normal and the hard swelling subsided.The course of treatment lasted for 19 days,the body temperature returned to normal and the patient recovered.Conclusions:This patient is a severe case of bubonic plague characterized with lymphangitis,skin sclerosis and abnormal coagulation.Timely identification,evaluation,early and combined treatment is the key to successful treatment.