Concomitant Staphylococcus Aureus Intra-Muscular Abscess after Dengue Hemorrhagic Fever ── A Case Report

登革熱合併感染金黃色葡萄球菌產生的肌肉膿瘍──病例報告

黃馨慧(Shin-Huei Huang) ； 鍾焜明(Kun Ming Chung) ； 陳俊嘉(Chun-Chia Chen) ； 劉澄(Cheng Liu) ； 林聿山(Yu-San Lin) ； 孫宗伯(Tzong-Bor Sun) ； 黃國峰(Kuo-Feng Huang) ； 邱浩遠(Haw-Yen Chiu) ； 葉敬淳(Chin-Choon Yeh)

《臺灣整形外科醫學會雜誌》 25卷1期 (2016/03) Pp. 58-63

摘要

背景：台南於今年爆發大規模登革熱感染疫情，感染人數高達22,719人（自104/5/1~104/12/12）2。目的及目標：我們提出一個出血性登革熱併發肌肉膿瘍的罕見病例並回顧臨床文獻。使用WHO 1997和2009的準則來定義出血性登革熱，警示症狀和登革熱重症。材料及方法：一名62歲的女性登革熱患者，本身有B型肝炎。今年8月底確診出血性登革熱，確診兩週後病患自述量測血壓後左上臂腫脹，否認任何外傷史。出院三周後卻發現左上臂更疼痛9月28日再度入院，經抗生素治療成效不彰，經MRI檢查，懷疑為肌肉中血塊或膿瘍，病人接受筋膜切開術，發現肌肉中膿瘍。細菌培養為金黃色葡萄球菌。結果：該患者於2015年10月15日康復出院，目前於門診追蹤，傷口癒合良好，上臂功能正常。結論：臨床醫師要小心登革熱重症的不正常變化，可能暗示著其他微生物的同時感染，即使微小創傷也可能造成血塊，且有轉為肌肉膿瘍的可能。

並列摘要

Background: An outbreak of dengue fever strike us in Tainan, Taiwan with 22719 cases conformed with diagnosis in 2015 (from 2015/5/1 to 2015/12/12) 2. Aim and objectives: This article presents a case of intramuscular abscess after dengue hemorrhagic fever and review of the literature. World Health Organization 1997, 2009 criteria were applied to define dengue hemorrhagic fever (DHF), warning signs and severe dengue. Materials and Methods: The patient was a 62-year-old female suffered from left arm swelling two weeks after diagnosis of dengue fever. She denied any trauma history except measuring blood pressure. Cellulitis was impressed initially. Antibiotic treatment was administered, but in vain. MRI revealed left triceps hematoma or abscess formation. Fasciotomy was performed and intramuscular abscess was confirmed. Pus culture yieled Staphylococcus aureus. Results: At the 1 month follow up, her wound healed well and there was no recurrence of infection. Conclusion: Clinicians should be cautious to unusual manifestations of dengue fever, which may signalize a concomitant infection by other microorganisms. Hematoma caused by minor trauma could become a source of abscess formation. (J Taiwan Soc of Plast Surg 2016;25:58～63)

並列關鍵字

concomitant infection ； co infection ； dengue fever ； staphylococcus aureus ； intra-muscular abscess