Salmonella Choleraesuis Bacteremia in Southern Taiwan

豬霍亂沙門氏桿菌菌血症病例之分例

陳彥旭(Yen-Hsu Chen) ； 陳田柏(Tyen-Po Chen) ； 盧柏樑(Po-Lian Lu) ； 蘇裕傑(Yu-Chieh Su) ； 黃高彬(Kao-Pin Hwang) ； 蔡季君(Jih-Jin Tsai) ； 鄭孝胥(Hsiao-Hsu Cheng) ； 彭健芳(Chien-Fang Peng)

《The Kaohsiung Journal of Medical Sciences》 15卷4期 (1999/04) Pp. 202-208

https://doi.org/10.6452/KJMS.199904.0202

摘要

沙門氏桿菌感染一直是全世界重要之感染症，在美國一年即有超過四萬個報告病例。在其兩千多種的血清分型中，豬霍亂沙門氏桿菌具有高度侵襲性，常分離自血液培養，並造成較嚴重之感染。因此我們收集民國八十年至八十五年間十九例住院至高雄醫學院之豬霍亂沙門氏桿菌菌血症病例，進行臨床及微生物之綜合分析。病人包括嬰兒、小孩及成人。年齡自八個月至八十歲，而平均年齡為步。病人男女比為3:1/。臨床症狀方面，以發燒(89.5%)、畏寒(57.9%)、厭食(52.6%)最常見；雖然沙門氏桿菌主要經由腸胃道感染，但有七位病例(36.8%)完全沒有腸胃道之症狀。實驗室檢查方面，大部份病人(36.8%)血中之白血球數目正常，但亦有31.6%之病人為白血球低下。十位(52.6%)病例其肝功能異常。具有嚴重之潛在疾病是此類病人之特色，尤其血液腫瘤方面之疾病(31.5%)，其次分別是肝硬化(26.3%)、全身性紅斑性狼瘡(10.5%)、慢性腎衰竭(10.5%)。此外有四例正在服用中藥。其中有一例為愛滋病患。在我們的研究中發現四例(21%)造成胃道外局部性之感染，包括：單側感染性踝關節炎、皮膚及皮下感染、自發性細菌性腹膜炎、肺炎。此菌之感染症死亡率頗高(21%)，而這可能和細菌本身之高致病性及病人之免疫功能嚴重低下有關。關於抗微生物藥劑之藥物感受性試驗結果，我們菌株對常用藥物具有相當高之抗藥性，包括：ampicillin’ chloramphenicol、TMP/SMZ 其抗藥性比例分別是94.7%、89.5%、63.8%，但幸運的是對第三代cephalosporins 及fluoroquinolones均具感受性。總結來說，在免疫功能嚴重低下之病人發生敗血症時，即使沒有腸胃道之症狀仍需將之列入鑑別診斷。治療方面則以第三代 cephalosporins 及fluoroquinolones為首選藥。

並列摘要

Within a 6-year period from January 1991 to December 1996, 19 patients with Salmonella choleraesuis bacteremia were enrolled for clinical and microbiological analysis. Young children, the elderly and patients with hematological malignancy (36.8%), liver cirrhosis (26.3%), systemic lupus erythematosus (10.5%), chronic renal impairment (10.5%), and peptic ulcer (10.5%) were at high risk of this infection. The ratio of male of female was 3:1. Three cases (15.8%)were nosocomially acquired. Fever (89.5%), chills (57.9%) and anorexia (52.6%) were the most common clinical manifestations. Seven patients (36.8%) presented no gastrointestinal manifestations. Normal white blood cell count was noted in seven patients (36.8%), and neutropenia caused by underlying diseases or sever infection was found in sis cases (31.6%). Various types of metastatic focal infections were found , such as septic arthritis, cutaneous infection, spontaneous bacterial peritonitis, and pneumonia. The severe immunocompromised status of patients and the high virulence of this pathogen may contribute to the high case fatality rate (21%). Higher resistance rate to commonly used antimicrobial agents was noted in ampicillin (94.7%), chloramphenicol (89.5%), and TMP/SMZ (63.8%). All strains of S. choleraesuis were susceptible to thirdgeneration cephalosporins and fluoroquinolones. Generally, S. choleraesuis bacteremia should be taken into account in the differential diagnosis of sepsis in immunocompromised patients, even without gastrointestinal manifestations. The third-generation cephalosporins and fluoroquinolones may be the first choice for treatment of this invasive infections.

並列關鍵字

bacteremia ； Salmonells choleraesuis ； antimicrobial susceptibility