新生儿类志贺邻单胞菌败血症1例并文献复习

Neonatal plesiomonas shigelloides septicemia:case report and literature review

目的探讨类志贺邻单胞菌新生儿败血症的临床特点。方法对深圳市龙岗中心医院新生儿科收治的1例类志贺邻单胞菌败血症患儿的临床资料进行回顾性分析,并以“类志贺邻单胞菌”、“败血症”、“plesiomonas shigelloides”、“septicemia”等为关键词,分别对中国知网、维普、万方、生物医学文献数据库、PubMed、Web of Science、Embase自建库至2022年4月收录的文献进行检索,总结已报道的新生儿类志贺邻单胞菌败血症患儿的临床特点。结果本例患儿为足月女婴,表现为气促、呻吟、低血压、感染性休克、肠道蠕动差,心肺彩超提示肺动脉高压、右侧胸腔积液(脓胸)、气胸等,血培养提示类志贺邻单胞菌生长,腰椎穿刺及颅脑影像学检查均无神经系统受累表现,经美罗培南、青霉素抗感染及对症治疗后痊愈出院,随访至1岁,未遗留后遗症。文献检索到14篇共14例新生儿类志贺邻单胞菌败血症相关文章,包括本例共15例。主要临床表现包括发热15例、惊厥/癫痫发作10例、黄疸及呼吸系统异常各8例、喂养困难及易激惹各6例等。头颅影像学特征为脑积水、全脑脑炎。治疗以抗生素及对症支持治疗为主,最终死亡8例,存活7例中2例有神经系统后遗症。结论新生儿类志贺邻单胞菌败血症临床表现无特异性,常累及多系统,神经系统受累明显,病死率高。

Objective To study the clinical characteristics of neonatal plesiomonas shigelloides(P.shigelloides)septicemia.Methods The clinical data of a neonate with P.shigelloides septicemia admitted to the Department of Neonatology of our hospital were reviewed.Literature on this subject were searched in the following databases:CNKI,CQVIP database,Wanfang Database,SinoMed,PubMed and Web of Science(up to April 2022).The clinical characteristics of reported cases of neonatal P.shigelloides septicemia were analyzed.Results Our patient was a full-term female neonate with symptoms of tachypnea,groaning,hypotension,septic shock and poor intestinal peristalsis.The cardiac and pulmonary ultrasound indicated pulmonary hypertension and right pleural effusion(empyema).The X-ray suggested pneumothorax.The blood culture showed P.shigelloides.Lumbar puncture and brain imaging showed no central nervous system involvement.After meropenem,penicillin and symptomatic treatment,the patient was cured and discharged without sequelae.In the literature review,14 articles and 14 cases of neonatal P.shigelloides septicemia were found(a total of 15 cases including our case).All 15 cases had fever,10 with convulsion/seizure,8 had jaundice,8 with respiratory distress/respiratory failure,6 had feeding difficulty and 6 were irritable.Brain imaging features were hydrocephalus and panencephalitis.Antibiotics and symptomatic treatment were the main therapy.8 cases died and 7 cases survived including 2 cases with neurological sequelae.Conclusions Neonatal P.shigelloides septicemia has nonspecific manifestations,often involves multiple organs with significant neurological involvement and a high mortality rate.