糖尿病、尿毒症、癌症患者之深頸部感染

Deep Neck Infection in Patients with Diabetes Mellitus, Uremia, or Cancer

何子建(Tzy-Chian Ho) ； 許振益(Chen-Yi Hsu)

《中華民國耳鼻喉科醫學會雜誌》 29卷3期 (1994/06) Pp. 191-196

https://doi.org/10.6286/1994.29.3.191

摘要

影響免疫功能的潛在疾病，包括糖尿病、癌症、尿毒症等。這些潛在疾病合併深頸部感染的臨床表徵和一般無潛在疾病者有所差異。本研究將自1988年以來本院深頸部感染104例病例，分為兩組：一為有免疫功能降低之潛在疾病組37例；另一為無潛在疾病組67例。就症狀、感染源、治療、膿液細菌培養、併發症及死亡率等做比較分析。結果發現發生於有潛在疾病導致免疫功能低下之深頸部感染患者有以下特徵：感染途徑不明確。多數為專一的病菌感染(Klebsiella pneumoniae)。臨床病程較為嚴重。併發症率和死亡率較高。

關鍵字

深頸部感染 ； 糖尿病 ； 克雷白氏肺炎桿菌

並列摘要

In order to investigate the differences of clinical manifestation in deep neck infection between immunocompromised and non-immunocompromised patients we collected and analyzed 104 cases of deep neck infection in 5 years at our hospital. There were 37 patients defined to be immunocompromised group according to the underlying diseases that would suppress immunity. The other 67 patients had no underying diseases and were classified as non-immunocompromised group. The study compared the initial symptoms, infection sources, infection spaces, bacterial cultures, complication, and mortality rates between the two groups. Diabetes mellitus was the leading underlying disease of immunocompromised patients in deep neck infection in this study (86.4%). The most possible sources of deep neck infection in immunocompromised group were unknown (54.1%), followed by URI (32.4%), dental origin (10.8%), and foreign body (2.7%). It was strikingly different from the general population of deep neck infection in which dental origin and URI were most frequently noted. The bacterial culture in non-immunocompromised patients was chiefly G (+) coccus including streptococcus and staphylococcus; but in the immunocompromised group was almost G ( ﹣) bacillus that it was dominated by Klebsiella pneumoniae. The significant importance of Klebsiella pneumoniae in immunocompromised patients with deep neck infection was proved by statistic results (p＜0.001) that suggested a specific correlation of pathogen and host immune status.
The clinical course of deep neck infection in immunocompromised group was more aggressive than the non-immunocompromised group, the former almost all needed surgical intervention (94.4%). The complication and mortality rates were obviously higher in immunocompromised patients than the non-immunocompromised patients. In conclusion, the unique features of deep neck infection in these immunocompromised patients are as follows: 1) a tendency of unclear infection source, 2) most caused by specific pathogen infection (Klebsiella pneumoniae), 3) more aggressive clinical course, 4) higher complication and mortality rate.

並列關鍵字

deep neck infection ； diabetes mellitus ； Klebsiella pneumoniae