中华结核和呼吸杂志
中華結覈和呼吸雜誌
중화결핵화호흡잡지
Chinese Journal of Tuberculosis and Respiratory Diseases
2012年
9期
683-686
,共4页
江立斌%朱奕豪%姚宇锋%徐峻%王真
江立斌%硃奕豪%姚宇鋒%徐峻%王真
강립빈%주혁호%요우봉%서준%왕진
沙门菌感染%猪瘟%胸腔积脓%气胸
沙門菌感染%豬瘟%胸腔積膿%氣胸
사문균감염%저온%흉강적농%기흉
Salmonella infections%Classical swine fever%Pleural empyema%Pneumothorax
目的 提高对猪霍乱沙门菌感染致脓气胸临床表现、诊断及治疗的认识.方法 报道2010年6月浙江中医药大学附属第一医院收治的1例猪霍乱沙门菌感染致脓气胸病例,并进行相关文献复习.以“猪霍乱沙门菌,脓胸”为检索词通过万方医学数据库对中文文献进行检索,以“Salmonella choleraesuis,thoracic empyema”为检索词通过PubMed检索系统进行检索.检索时间截至2011年5月.结果 患者女,43岁,患糖尿病,因“发热伴右胸痛4d”入院.胸部CT示右侧胸腔内混杂密度影,上至胸腔顶部,下至膈面,团块状高密度影周围与内部可见不规则气体密度影,未见气液平面.血培养、气管镜下吸取的支气管分泌物培养沙门菌阳性.最初静脉给予抗生素(先后给予哌拉西林/他唑巴坦、头孢他啶、亚胺培南-西司他丁)治疗无效.后经开胸手术治疗,右侧脓胸清除,留置胸管闭锁引流.胸腔积液培养猪霍乱沙门菌阳性.术后反复进行右侧胸腔冲洗引流,并给予抗生素等综合治疗,患者好转出院.以“猪霍乱沙门菌,脓胸”为检索词在万方医学数据库检索未见到相关报道.以“Salmonella choleraesuis,thoracic empyema”为检索词在PubMed检索系统检索到3篇文献,2篇为个案报道,1篇为回顾性分析.共报道973例胸腔积液细菌培养阳性病例,其中12例为沙门菌属,男9例,女3例,平均年龄49岁,其中10例合并恶性肿瘤、肝硬化、糖尿病等基础疾病,机体免疫力低下.12例中,7例为猪霍乱沙门菌感染,其中4例死亡.结论 猪霍乱沙门菌感染致脓气胸或脓胸较为罕见,病死率高.多发生于存在基础疾病、机体免疫力低下者.三四代头孢菌素或碳青霉烯类抗生素治疗的同时,尽快行脓胸清除术并冲洗引流,患者预后良好.
目的 提高對豬霍亂沙門菌感染緻膿氣胸臨床錶現、診斷及治療的認識.方法 報道2010年6月浙江中醫藥大學附屬第一醫院收治的1例豬霍亂沙門菌感染緻膿氣胸病例,併進行相關文獻複習.以“豬霍亂沙門菌,膿胸”為檢索詞通過萬方醫學數據庫對中文文獻進行檢索,以“Salmonella choleraesuis,thoracic empyema”為檢索詞通過PubMed檢索繫統進行檢索.檢索時間截至2011年5月.結果 患者女,43歲,患糖尿病,因“髮熱伴右胸痛4d”入院.胸部CT示右側胸腔內混雜密度影,上至胸腔頂部,下至膈麵,糰塊狀高密度影週圍與內部可見不規則氣體密度影,未見氣液平麵.血培養、氣管鏡下吸取的支氣管分泌物培養沙門菌暘性.最初靜脈給予抗生素(先後給予哌拉西林/他唑巴坦、頭孢他啶、亞胺培南-西司他丁)治療無效.後經開胸手術治療,右側膿胸清除,留置胸管閉鎖引流.胸腔積液培養豬霍亂沙門菌暘性.術後反複進行右側胸腔遲洗引流,併給予抗生素等綜閤治療,患者好轉齣院.以“豬霍亂沙門菌,膿胸”為檢索詞在萬方醫學數據庫檢索未見到相關報道.以“Salmonella choleraesuis,thoracic empyema”為檢索詞在PubMed檢索繫統檢索到3篇文獻,2篇為箇案報道,1篇為迴顧性分析.共報道973例胸腔積液細菌培養暘性病例,其中12例為沙門菌屬,男9例,女3例,平均年齡49歲,其中10例閤併噁性腫瘤、肝硬化、糖尿病等基礎疾病,機體免疫力低下.12例中,7例為豬霍亂沙門菌感染,其中4例死亡.結論 豬霍亂沙門菌感染緻膿氣胸或膿胸較為罕見,病死率高.多髮生于存在基礎疾病、機體免疫力低下者.三四代頭孢菌素或碳青黴烯類抗生素治療的同時,儘快行膿胸清除術併遲洗引流,患者預後良好.
목적 제고대저곽란사문균감염치농기흉림상표현、진단급치료적인식.방법 보도2010년6월절강중의약대학부속제일의원수치적1례저곽란사문균감염치농기흉병례,병진행상관문헌복습.이“저곽란사문균,농흉”위검색사통과만방의학수거고대중문문헌진행검색,이“Salmonella choleraesuis,thoracic empyema”위검색사통과PubMed검색계통진행검색.검색시간절지2011년5월.결과 환자녀,43세,환당뇨병,인“발열반우흉통4d”입원.흉부CT시우측흉강내혼잡밀도영,상지흉강정부,하지격면,단괴상고밀도영주위여내부가견불규칙기체밀도영,미견기액평면.혈배양、기관경하흡취적지기관분비물배양사문균양성.최초정맥급여항생소(선후급여고랍서림/타서파탄、두포타정、아알배남-서사타정)치료무효.후경개흉수술치료,우측농흉청제,류치흉관폐쇄인류.흉강적액배양저곽란사문균양성.술후반복진행우측흉강충세인류,병급여항생소등종합치료,환자호전출원.이“저곽란사문균,농흉”위검색사재만방의학수거고검색미견도상관보도.이“Salmonella choleraesuis,thoracic empyema”위검색사재PubMed검색계통검색도3편문헌,2편위개안보도,1편위회고성분석.공보도973례흉강적액세균배양양성병례,기중12례위사문균속,남9례,녀3례,평균년령49세,기중10례합병악성종류、간경화、당뇨병등기출질병,궤체면역력저하.12례중,7례위저곽란사문균감염,기중4례사망.결론 저곽란사문균감염치농기흉혹농흉교위한견,병사솔고.다발생우존재기출질병、궤체면역력저하자.삼사대두포균소혹탄청매희류항생소치료적동시,진쾌행농흉청제술병충세인류,환자예후량호.
Objective To improve understanding of the clinical features,diagnosis and treatment of pyopneumothorax caused by Salmonella choleraesuis. Methods One case of pyopneumothorax caused by Salnonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed.As of May 2011,the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database. Results A 43 year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital.ACT scan of the chest revealed a massive shadow with mixed density in the right hemithorax,from the top of thorax to diaphragmatic surface,and there was air inside or surrounding the mass irregularly but without an air-fluid level.Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam,ceftazidime,and then imipenem-cilastatin) was ineffective.Open chest surgery was performed,and chest tube placed.Salmonella choleraesuis was isolated from the drained pleural fluid.Chest tube drainage remained in place for more than 6 weeks,and with prolonged antibiotic therapy,which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online,while 3 literatures were found in Pubmed,including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study,12 of these patients,including 9 men and 3 women,were infected with Salmonella species. The median age was 49 years,and 10 patients were immunocompromised,including malignancy,liver cirrhosis,and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis,and 4 (57％) of them died.Conclusions Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis,appropriate antimicrobial drug therapy,and aggressive drainage are necessary to improve the outcome of patients with pyopneumothorax or thoracic empyema due to Salmonella choleraesuis.
