少见贪铜菌感染致心内膜炎1例并文献复习

A Case of Infective Endocarditis Caused by Cupriavidus Paucula and Literature Review

少见贪铜菌是一种非发酵氧化酶阳性无芽孢革兰阴性杆菌。该菌属条件致病菌,很少引起人类感染,感染该菌的患者多具有明确的免疫低下因素。通过分析1例无明确免疫缺陷的中年男性患者感染少见贪铜菌并致心内膜炎的临床资料,结合文献复习提示新型冠状病毒感染会导致T淋巴细胞持续减低,它与巨细胞病毒的感染、糖尿病的高血糖状态可能是导致该病例免疫功能特别是细胞免疫功能低下,进而感染机会致病菌的潜在原因。这一病例提示对新型冠状病毒感染后再次出现不明原因感染性发热患者,应注重病原学检测,警惕机会致病菌及不典型病体感染可能,依据结果及时选用敏感药物治疗,防止经验性治疗不能覆盖病原体而导致感染进展等不良预后。

Cupriavidus paucula is a non-fermenting,oxidase-positive,Gram-negative rod bacterium that does not form spores.It is considered an opportunistic pathogen and rarely causes infections in humans.Patients infected with it often have identifiable immunodeficiency factors.In this study,we present a clinical case of infective endocarditis caused by Cupriavidus paucula in a middle-aged male patient without apparent immunodeficiency.Based on the literature review,we hypothesize that the persistent reduction of T lymphocytes associated with COVID-19 infection,along with human cytomegalovirus infection and hyperglycemia in diabetes,may have contributed to the impaired immune function,particularly cellular immunity,thereby increasing the susceptibility to opportunistic pathogens in this case.This case highlights the importance of pathogen detection and being vigilant about opportunistic pathogens or atypical infections in patients presenting with recurrent unexplained infectious fever after COVID-19 infection.Prompt selection of sensitive antibiotics based on the pathogen detection results is crucial to prevent inadequate treatment that may fail to cover the causative agents,leading to unfavorable outcomes.