Melioidosis Mimicking Septic Embolism-A Case Report

以敗血性血栓症為臨床表現的類鼻疽－病例報告

李佳霖(Chia-Lin Lee) ； 江啟輝(Chi-Huei Chiang)

《胸腔醫學》 22卷2期 (2007/04) Pp. 146-152

https://doi.org/10.29806/TM.200704.0012

摘要

類鼻疽(Melioidosis)是由類鼻疽伯克氏菌(Burkholderia pseudomallei)所感染造成的疾病。此病菌在東南亞及澳洲北部為相當重要的致病菌。類鼻疽經常造成肺部發炎性浸潤及嚴重的敗血症，而後者伴隨著相當高的死亡率。縱使合併使用多種有效的抗生素，死亡率仍居高不下。近年來，自此病被列為「傳染病個案報告單」之新增通報項目後，衛生單位已陸續接獲並證實有本土之散發性病例發生。
在此，我們報告一位52歲酗酒並罹患糖尿病的男性病人以左肩、左臀部疼痛及發燒、咳嗽來表現。一系列的胸部影像檢查疑似敗血性血栓症(septic embolism)，而痰液及血液培養證實是類鼻疽。合併使用靜脈注射抗生素ceftazidime（第三代頭孢子素）及trimethoprim-sulfamethoxazole（磺胺類藥物）治療24天後，病人的臨床症狀及胸部X光得到迅速顯著的進步。繼之以口服levofloxacin 10週的加強治療。
在本文中，我們將進一步探討類鼻疽的臨床表徵，及治療用藥的選擇。

關鍵字

類鼻疽 ； 類鼻疽伯克氏菌 ； 敗血性血栓症 ； 肺炎

並列摘要

Melioidosis is infection with the Gram-negative bacterium Burkholderia pseudomallei. It is an important cause of sepsis in eastern Asia and northern Australia, and it often causes respiratory involvement and fatal fulminant septicemia. The mortality rate is high despite suggested therapy with ceftazidime, co-trimoxazole, amoxicillin-clavulanate, chloramphenicol, and tetracyclines. The number of documented cases in Taiwan has been increasing in recent decades, and melioidosis is regarded as an emerging infection. We report the case of a 52 year-old alcoholic male with diabetes who presented with severe left shoulder and left buttock pain, followed by respiratory symptoms. Chest radiograph and computed tomography disclosed findings mimicking septic embolism. A confirmed diagnosis of melioidosis was made via isolation of B. pseudomallei from the sputum and the blood sample. The patient was treated successfully with the combination of intravenous ceftazidime and trimethoprim-sulfamethoxazole, followed by maintenance therapy with oral levofloxacin.

並列關鍵字

melioidosis ； Burkholderia pseudomallei ； septic embolism ； pneumonia