1例蠊缨滴虫感染报告

A case report of Lophomonas blattarum infection

蠊缨滴虫感染在门诊感染中少见,易被忽略。本文通过对1例感染者的就诊过程作一详细描述,供临床医师借鉴。患者,男,62岁。长住连云港赣榆区打工。患者于2020年9月15日淋雨劳累后出现发热,咳痰,自行服药,热退。3 d后再次发热,并伴右侧胁肋部疼痛,遂至赣榆区人民医院就诊。该院检查WBC 19.74×10^(9)/L,N 83.7%,超敏C反应蛋白33.19 mg/L;CT示右肺中叶及两下肺叶炎症,右侧胸腔积液。该院给予抗感染及化痰治疗共3 d,效果欠佳。22日转至江苏省中医院,血液示超敏C反应蛋白65.8 mg/L,WBC 11.66×10^(9)/L,E 6.9%。CT示两肺多发结节及片状影。肺功能示肺通气功能减退。纤支镜洗液检查示存在感染。同时将纤支镜洗液送南京市疾控中心作寄生虫学相关检查。该院考虑患者肺炎,给予抗真菌及化痰治疗3 d,效果不明显。此时南京市疾控中心反馈寄生虫检测结果示蠊缨滴虫阳性。该院遂加用奥硝唑治疗,一周后患者发热、咳嗽、胸痛等症状消失,相关感染指标均恢复正常,痊愈出院。患者在两家医院以临床医生的经验先后使用抗生素治疗,效果不明显。在确定是蠊缨滴虫(同时还应注意与支气管纤毛柱状上皮细胞相鉴别)后,及时采用奥硝唑治疗,效果显著,症状很快消失。提示临床医生找对病原采用针对性治疗非常重要,蠊缨滴虫在临床感染的患者中少见,又缺乏检测手段,更易漏诊,须警惕。

Lophomonas blattarum infection is rare in outpatients,which is easily to be overlooked.This article briefly introduces the symptoms of an infected person,the examination,differential diagnosis and treatment measures that we have taken for clinical reference.The patient is male,62 years old,long live and work in Ganyu district,Lianyungang.On September 15,2020,the patient developed fever,expectoration after the rain,and fever regression after self-medication.Three days later,he developed fever again,accompanied by pain in the right flank,and went to Ganyu District People's Hospital for treatment.With WBC 19.74×10^(9)/L,N 83.7%,hypersensitive C-reactive protein 33.19 mg/L;CT showed inflammation in the middle lobe of the right lung and two lower lobes,and effusion in the right pleural cavity.The hospital gave anti-infection and phlegm treatment for 3 days,but the effect was not good.On 22nd,he was transferred to Jiangsu Hospital of Traditional Chinese Medicine.The blood routine showed hypersensitive C-reactive protein 65.8 mg/L,WBC 11.66×10^(9)/L and E 6.9%.CT showed multiple nodules and patchy shadows in both lungs.Lung function showed decreased pulmonary ventilation function.Fibrobronchoscopy revealed the presence of infection.Meanwhile,the fibrobronchoscope lotion was sent to Nanjing Center for Disease Control and Prevention for parasitological examination.The hospital considered pneumonia and gave anti-fungal and expectorant treatment for 3 days,but the effect was not good.At this time,Nanjing Center for Disease Control and Prevention reported positive Lophomonas blattarum test results.The hospital then added ornidazole treatment,one week later,the patient's fever,cough,chest pain and other symptoms disappeared,related infection indicators returned to normal,recovered and discharged.In this case,the patient was treated with antibiotics successively in two hospitals according to the experience of clinicians,but the effect was not good.Ornidazole treatment was timely adopted after the identification of Lophomonas blattarum(at the same time,attention should be paid to the identification with the bronciliated columnar epithelial cells),and the effect was significant,and the symptoms soon disappeared.It suggests that it is very important for clinicians to use targeted treatment for pathogens.Lophomonas blattarum is rare in patients with clinical infection and lack of detection means,so it is easier to miss diagnosis,so vigilance should be taken.