親水性產氣單胞菌導致酒精肝硬化患者重度敗血症之個案報告

Aeromonas hydrophilia induced Sepsis in alcoholic liver cirrhosis patient: a Case Report

蘇文麟(Wen-Lin Su) ； 吳燿光(Yao-Kuang Wu) ； 鐘雪文(Hsueh-Wen Chung) ； 顏鴻欽(Horng-Chin Yan)

《中華職業醫學雜誌》 23卷1期 (2016/01) Pp. 65-70

摘要

簡介: 親水性產氣單胞菌感染有時會導致菌血症，在免疫不全的病患，甚至會惡化至敗血性休克，並導致死亡。過去少見親水性產氣單胞菌的職業病案例報告。本研究報告一位肝硬化患者，從事水族飼養業，因工作導致皮膚傷口接觸淡水魚類，感染親水性產氣單胞菌併發菌血症及急性呼吸窘迫症，及其診斷以及快速復甦的治療過程。案例報告: 一位55歲男性被送來急診，呈現黃疸、發燒、休克及急性呼吸窘迫症。經立即採輸液復甦和經驗性抗生素治療，氣管插管後住院至加護病房照護。血液培養結果為親水性產氣單胞菌，經治療17天後順利拔管出院。結論: 酒精性肝硬化患者因免疫力下降，可能經由傷口或食入而感染親水性產氣單胞菌導致敗血症及急性呼吸窘迫症，免疫力不全的病人生活環境宜避免開放性傷口未經適當保護下，直接接觸可能遭細菌感染的汙水，如本案例從事水族館飼養業，若發生感染時，應立即就醫，依照感染及敗血症相關診療指引，積極重症照護可以成功有效的治療此類病患。

關鍵字

親水性產氣單胞菌 ； 敗血症 ； 急性呼吸窘迫症 ； 肝硬化

並列摘要

Introduction: Aeromonas hydrophilia can sometimes infect human and cause bacteremia. There are limited reports in the literature of Aeromonas hydrophilia bacteremia due to occupational exposure. We presented a case with underlying alcoholic liver cirrhosis, who was engaged in aquarium breeder business and had his open skin wound in contact with fresh water fish during work without proper protection. Bacteremia, severe sepsis, and acute respiratory distress syndrome developed and he was admitted to ICU for treatment. The treatment was successful and the patient was discharged home three weeks later. Case reports: A 55-year-old male was sent to emergency room with jaundice, fever, shock, and acute respiratory distress syndrome. He received aggressive initial fluid resuscitation and broad-spectrum empiric antibiotic treatment. He was intubated and admitted to ICU for intensive monitoring and care. Blood culture yielded Aeromonas hydrophilia. After 17 days of treatment, he was successfully weaned from mechanical ventilation, extubated and discharged home. Conclusion: Aeromonas hydrophilia may infect immune compromised hosts, such as alcoholic liver cirrhosis in this case via direct wound contact or eating under-cooked contaminated foods. Once infected, it may cause severe sepsis and acute respiratory distress syndrome in some cases. Immune compromised hosts should have proper protection to prevent infection in their workplace and living environment, especially when they have open skin wounds. When infected, patient should look for medical attention immediately. With proper treatment and without delay, it can be cured.

並列關鍵字

Aeromonas hydrophilia ； sepsis ； acute respiratory distress syndrome ； liver cirrhosis