副百日咳鲍特菌合并肺炎支原体感染一例并文献复习

A case of Bordetella parapertussis complicated with Mycoplasma pneumoniae infection and literatures review

目的探讨副百日咳鲍特菌感染的临床及病原学特点。方法收集2020年9月14日就诊于湖北省天门市第一人民医院1例副百日咳鲍特菌合并肺炎支原体感染患儿的病例资料,分析该病例的病程记录和实验室对病原菌的分离鉴定过程并复习相关文献。结果患儿、女、1岁3个月,临床表现为咳嗽、气喘等,轻度吸气三凹征,双肺呼吸音粗糙,可闻及中量哮鸣音、少许湿啰音,实验室检查白细胞计数:12.49×10^(9)/L、红细胞计数:4.36×10^(12)/L、中性粒细胞占比58.4%、血小板计数:260×10^(9)/L、血清铁:7.5μmol/L、肌酐:26.5μmol/L、总二氧化碳:19.6 mmol/L、总钙:2.76 mmol/L、羟丁酸脱氢酶:291 U/L、乳酸脱氢酶:310 U/L、肌酸激酶同工酶:25.20 U/L、肌酸激酶:308 U/L;肺炎支原体IgM抗体:弱阳性。患者胸部影像学CT显示右上肺见片状高密度影。痰培养分离菌经蛋白飞行时间质谱(MALDI-TOF MS)鉴定为副百日咳鲍特菌。该患儿经抗感染治疗后好转出院。结论副百日咳鲍特菌感染相对少见,尽早行病原学诊断对其有效治疗具有重要意义。

Objective To investigate the clinical and pathogenic characteristics of Bordetella parapertussis infection.Methods Clinical data of the patient who was admitted to the First People’s Hospital of Tianmen City was collected,the disease course records of this patient and the laboratory isolation and identification process of the pathogenic bacteria were analyzed and the relevant literatures were reviewed.Results This child,female,1 year and 3 months old,with clinical manifestations such as cough and shortness of breath,mild inspiratory trigeminal sign,coarse breath sounds in both lungs,moderate croup and a few wet rales could be heard;laboratory examination results showed that white blood cells:12.49×10^(9)/L,red blood cells:4.36×10^(12)/L,neutrophil percentage:58.4%,platelets:260×10^(9)/L,serum iron:7.5μmol/L,creatinine:26.5μmol/L,total carbon dioxide:19.6 mmol/L,total calcium:2.76 mmol/L,hydroxybutyate dehydrogenase:291 U/L,lactate dehydrogenase:310 U/L,creatine kinase isoenzyme:25.20 U/L,creatine kinase:308 U/L;Mycoplasma pneumoniae IgM antibody:weakly positive.The patient’s chest CT imaging showed a sheet of high-density film of the right upper lung.The sputum culture isolates were identified as Bordetella parapertussis by protein time-of-flight mass spectrometry(MALDI-TOF MS).The child was discharged from hospital after anti-infection treatment.Conclusion Bordetella parapertussis infection is relatively rare,and early pathogen diagnosis is important for effective treatment.