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Aeromonas Hydrophila Septicemia with Myonecrosis and Gas Gangrene in a Patient Receiving Hemodialysis
接受螯鐵劑治療尿毒病患感染親水性產氣單胞菌敗血症合併肌肉壞死及氣疽－病例報告
摘要
一位四十九歲女性因慢性腎絲球腎炎接受合併尿毒症長期血液透析治療，鋁骨病變，在投與螯鐵劑（DFO）治療6個月後出現嚴重的雙側下肢疼痛、發冷、發燒。兩天後雙側下肢產生肌肉壞死和氣疽而死亡。血液和雙側下肢肌肉抽取液培養皆長出親水性產氣單胞菌（Aeromonas hydrophila）。除動靜脈寠管傷口有輕微出血外，並無明顯感染途徑可尋。文獻記載，只有二位血液透析病患感染此菌造成敗血症，我們推測動靜脈屢管皮膚針口接觸到感染此菌的水源或透析系統遭此菌感染，造成此菌侵入身體。親水性產氣單胞菌對骨路肌肉有很高的親和性，在臨床上，此格蘭氏陰性的細菌很難與格蘭氏陽性的梭狀菌（Clostridium）造成的肌肉壞死及氣疽區別。藉著格蘭氏染色，早期辨識此細菌，積極的外科手術及適當抗生素或許可阻止病人的死亡。
並列摘要
A 49-year-old woman undergoing long-term hemodialysis and receiving deferoxamine due to aluminum bone disease for 6 months developed severe bilateral calf pain, chills and fever. Myonecrosis with gas gangrene over both lower limbs was noted 2 days later. She had a rapidly fatal outcome. The cultures of blood and aspirates from both calf muscles demonstrated Aeromonas hydrophila. NO obvious entry point could be traced except bleeding from the punctured wound at the arteriovenous fistula. To our knowledge, only two reported uremic patients receiving hemodialysis developed A. hydrophila septicemia. We speculate that the punctured site at the arteriovenous fistula coming into contact with contaminated water or contamination in the dialysis system contributed to this bacterial entry. A. hydrophila exhibits an avidity for skeletal muscles. Rapid recognition of myonecrosis attributed to this uncommon organism by gram staining, early aggressive surgery and appropriate antibiotics may circumvent this catastrophic outcome.
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