类鼻疽骨、关节及骨髓感染的临床特点

Clinical characteristics of melioidosis bone, joint and bone marrow infection

目的分析类鼻疽骨、关节及骨髓感染的临床特征,为类鼻疽骨、关节及骨髓感染的诊治提供参考,减少漏诊和误诊,提高患者预后。方法回顾性分析21例类鼻疽骨、关节及骨髓感染患者的流行病学和临床特点;采用Etest法检测致病菌对抗菌药物的敏感性。结果 21例患者中男19人,女2人,年龄范围35~80岁,8人职业为农民,11人在台风季节后发病;21位患者中有糖尿病者18人,低蛋白者8人,抽烟、酗酒各6人。21例患者中骨感染者6例,其中4例为股骨受累,关节感染者13例,其中膝关节受累7例,骨髓感染者7例;患者合并血流感染者19人,合并肺部感染者14人。患者临床表现中,发热最常见(19人),其次为感染局部疼痛(17人);患者的实验室检查中,白细胞或中性粒细胞百分比、CRP等炎性指标普遍增高;MRI和CT检查能够发现感染病变,而X线检查类鼻疽骨关节感染的灵敏度较差;足疗程抗生素联合外科治疗效果较好,经抗生素和/或外科治疗后,复发3人,死亡6人,死亡率28.6%。致病菌对亚胺培南、头孢他啶全部敏感,未检出对阿莫西林/克拉维酸和四环素耐药的菌株,对复方磺胺甲噁唑的耐药率较高,为28.6%。结论对于台风季节后发病、有水土接触史、有骨关节症状的糖尿病患者,特别是合并菌血症或肺部感染症状及骨关节局部疼痛时,应考虑类鼻疽骨关节或骨髓感染的可能,在明确诊断后结合必要的外科治疗和足疗程的抗生素治疗,以提高患者的预后。

ObjectiveTo analyze the clinical characteristics of bone, joint and bone marrow infection of Burkholderia pseudomallei, so as to provide reference for the diagnosis and treatment of melioidosis osteomyelitis and septic arthritis, toreduce the rate of missed diagnosis and misdiagnosis, and improve the prognosis of patients.MethodsThe epidemiologicaland clinical features of 21 patients with bone, joint and bone marrow infection were retrospectively analyzed. The susceptibilityof Burkholderia pseudomallei to antimicrobial agents was tested by Etest method.ResultsAmong the 21 patients, 19 weremale and 2 were female, the age range was 35-80 years old, eight were farmers, symptoms appeared in 11 patients after thetyphoon season;18 had diabetes, 8 with hypoproteinemia, 6 were smokers and 6 were alcoholics;6 were infected with bone, 4 ofwhich were femoral involvement, 13 were joint infection, including 7 cases of knee joint involvement, 7 were bone marrowinfection. In addition to the infection of bone, joint and bone marrow, 19 patients were combined with bloodstream infection,and 14 with pneumonia. Fever was the most common(19 cases) clinical manifestation, followed by local pain(17 cases);As tolaboratory examination, WBC count or percentage of leukocytes, CRP and other inflammatory indicators generally increased.MRI and CT examination can detect infectious lesions, but the sensitivity of X-ray is poor;Therapy combined with long-termantibiotics and surgery was effective, 3 cases relapsed and 6 cases died despite of antibiotic and/or surgical treatment, the mortality rate was 28.6%. Burkholderia pseudomallei strains were all sensitive to imipenem and ceftazidime, no resistant strainsto amoxicillin/clavulanic acid and tetracycline were detected. The resistance rate of SMZ-TMP was 28.6%.Conclusions For diabetic patients who developed bone and joint symptoms after typhoon season, with the history of soil or water contact,especially when combined with bacteremia or pneumonia, the possibility of melioidosis osteoarticular or bone marrow infectionshould be considered. Adequate course of antibiotic and necessary surgical treatment should be applied to improve theprognosis of the patient.