以下頜下腺炎之復發性類鼻疽

Relapsing Melioidosis as Cause of Submandibular Sialoadenitis

林敬家(Ching-Chia Lin) ； 林嘉德(Chia-Der Lin) ； 蔡銘修(Ming-Hsui Tsai) ； 何茂旺(Mao-Wang Ho) ； 王任賢(Jen-Hsien Wang)

《台灣耳鼻喉頭頸外科雜誌》 39卷3期 (2004/06) Pp. 124-128

https://doi.org/10.6286/2004.39.3.124

摘要

類鼻疽是一由Burkholderia pseudomallei所引起之感染，類鼻疽常發生於熱帶地區，特別是東南亞如泰國、越南等，並且有很高之死亡率，但在台灣並不常見。而造成下頜下腺膿瘍更為少見。本病例為一45歲男性，有糖尿病之病史，於2001年因肺膿瘍而住院，檢查發現有黴菌性胸腹主動脈瘤（mycotic aneurysm），病人接受膿胸引流併主動脈瘤切除及修補手術，其血液細菌培養為Burkholderia pseudomallei。出院後病人接口服amoxicillin/clavulanic acid 700 mg q8h連續治療6個月。於2003年8月，患者左側下頜下腺持續腫脹並伴隨發燒，電腦斷層攝影顯示為左側下頜下腺震瘍，於是安排左下頜下腺切除手術，病理報告呈顯微震瘍，而組織膿液細菌培養為Burkholderia pseudomallei，患者術後恢復良好。因病例罕見，故提出報告。

關鍵字

類鼻疽 ； 類鼻疽伯克氏菌 ； 下頜下腺

並列摘要

Melioidosis is an infection caused by Burkhoderia pseudomallei. It is an endemic disease in the rainy season in tropical area, especially in Thailand and Vietnam. Burkholderia pseudomllei is widely distributed in the water and soil of the tropics. This potentially fatal infectious disease is not common in Taiwan. Burkholderia pseudomallei is a gram negative, non-spore-forming, aerobic bacillus. Transmission is almost through direct contact. It may manifest itself as pulmonary lesion, abscess in soft tissue or various organs or in septicemic form. Submandibular gland melioidosis has not been reported so far. Ceftazidime is the treatment of choice for severe melioidosis. Maintenance antibiotics treatment is combination of chloramphenicol, doxycyline, and trimethoprim/sulfamethoxazole, or with amoxicillin/clavulanic acid. Relapse may occur many years later. We report the case with submandibular gland and adequate antibiotics were performed. Melioidosis should be considered in the differential diagnosis of any patient with abscess located in head and neck region in Taiwan.

並列關鍵字

melioidosis ； Burkholderia pseudomallei ； submandibular gland