晚期癌症患者合并巴贝虫感染1例

A case of late stage tumor combined with Babesia infection

患者,女,57岁,温州市鹿城区人。2021年9月28日因胸闷头晕10余天到温州市中心医院就诊,入院体查:慢性病容,意识清楚,皮肤黏膜无黄染,无水肿,有瘢痕,以“胸闷待查”收住心内科治疗,后因癌性胸水在院内转化疗科。10月8日起出现反复发热。实验室检查:血红蛋白86 g/L,红细胞计数2.74×1012/L,中度贫血;白细胞计数12.7×10^(9)/L,中性粒细胞绝对数10.6×10^(9)/L,总胆红素、间接胆红素轻度升高;尿液培养检出3种以上细菌,尿隐血持续2+。10月25日进行血涂片瑞氏染色镜检,查见部分红细胞内有1~4个紫红色核、蓝色胞浆环状体,考虑寄生虫感染。患者长期居住于温州市区,无国内、外旅居史,无明确蜱虫叮咬史。患者曾于2005年行左乳癌保乳术,2014—2021年因多次发现肺部转移灶入院进行化疗与靶向药物治疗;2021年6—10月先后进行12次输血治疗。取患者外周血液提取DNA,经巴贝虫属特异性引物PCR扩增后测序,所获序列与田鼠巴贝虫(GenBank登录号:MG674832.1)的序列一致性高达99.43%。确诊该患者为田鼠巴贝虫感染。患者经口服磷酸氯喹片(0.5 g/d,首剂加倍,连服5 d)和克林霉素(600 mg/d+生理盐水500 ml静脉滴注,连续10 d)治疗,症状有所缓解,5 d后血涂片镜检仍查见巴贝虫。巴贝虫感染导致的高热、黄疸、溶血等症状在一定程度上加剧了患者终末期癌症病情的发展,于11月8日因多器官衰竭抢救无效而死亡。

A 57⁃year⁃old female patient from Lucheng District was admitted to Wenzhou Central Hospital on September 28,2021.The examination on admission showed the chronic disease face and clear consciousness;the skin and mucous membranes had no yellowish staining nor oedema but were scared.The patient was admitted to the cardiology department with“chest tightness pending further investigation”and was later transferred to the chemo⁃therapy department due to cancerous pleural fluid.The patient had a recurrent fever since October 8.Laboratory tests showed the haemoglobin was 86 g/L,the red blood cell count was 2.74×1012/L suggesting moderate anaemia.The leukocyte count was 12.7×10^(9)/L,the absolute neutrophil count was 10.6×10^(9)/L.The patient also had mildly elevated total and indirect bilirubin;urine culture detects mixed growth of more than 3 bacteria,persistent urinary occult blood 2+.Wright􀆳s stain of the blood smear was performed on October 25,microscopic examination showed that 1-4 ringlets with purplish⁃red nuclei and blue cytoplasmic could be found in some red blood cells,which was considered to be a parasitic infection.The patient was a long⁃term resident of urban Wenzhou with no history of do⁃mestic or international travel,and no clear history of tick bites.The patient underwent breast⁃conserving surgery for left breast cancer in 2005,received chemotherapy and targeted drug therapy for multiple lung metastases between 2014 and 2021 and had 12 blood transfusions from June to October 2021.The PCR product of blood DNA amplifi⁃cated by primers specific to Babesia was sequenced and identified with 99.43%homology to B.microti(GenBank ac⁃cession:MG674832.1).The diagnosis of Babesia microti infection was confirmed.The patient was treated with oral chloroquine phosphate tablets(0.5 g/d,double the first dose for 5 d)and intravenous clindamycin(600 mg/d+saline 500 ml intravenously for 10 d),with some relief of symptoms,and parasites were still detected on microscopic exami⁃nation after 5 days.The symptoms of high fever,jaundice and haemolysis caused by Babesia infection somewhat ex⁃acerbate the progression of terminal⁃stage cancer.On November 8,the patient died of multi⁃organ failure and unsuc⁃cessful resuscitation.