中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2013年
1期
42-45
,共4页
Lemierre综合征%隐秘杆菌属%静脉血栓形成,颈
Lemierre綜閤徵%隱祕桿菌屬%靜脈血栓形成,頸
Lemierre종합정%은비간균속%정맥혈전형성,경
Lemierre syndrome%Arcanobacterium%Venous thrombosis,neck
目的 提高对溶血隐秘杆菌致Lemierre综合征的认识及诊治水平.方法 分析1例溶血隐秘杆菌致Lemierre综合征的临床特点,并进行文献复习.结果 患者男,无诱因发热伴咽痛,体检发现左侧扁桃体充血、肿大,血常规正常,X线胸部正位片未见异常.初步诊断:急性扁桃体炎(左侧).予青霉素+阿奇霉素治疗后,症状加重,查白细胞计数13.59×109/L,中性粒细胞比例0.933,血小板计数7.4×109/L;TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,血清白蛋白19.3 g/L.血培养结果为溶血隐秘杆菌,改静脉滴注哌拉西林-他唑巴坦治疗后体温恢复正常.随后患者出现左侧颈内静脉血栓形成,予抗凝治疗.出院后2个月和4个月时随访患者,未见异常.检索文献3例,结合本例共4例,4例患者均为男性,年龄19 ～54岁,均以咽痛和发热为首发和主要症状,均伴有颈部疼痛；咽炎2例,扁桃体周围渗出或脓肿各1例,皮疹2例；血白细胞计数均升高,血小板计数均下降,肝功能损伤3例,急性肾衰竭2例,急性呼吸衰竭1例；首查X线胸片均正常,病情进展后胸部X线或CT提示双肺周边多发结节高密度影伴空洞形成3例,局灶或楔形浸润影1例,胸腔积液1例；血培养结果提示单一溶血隐秘杆菌2例,溶血隐秘杆菌和坏死梭形杆菌复合感染2例；4例患者均应用青霉素+酶抑制剂治疗有效；有血栓者予抗凝治疗；无死亡病例.结论 Lemierre综合征临床特点有原发口咽部感染、脓毒血症、感染性或栓塞性颈静脉炎及至少一处远处化脓灶,早期诊断、及时治疗可降低溶血隐秘杆菌致Lemierre综合征病死率.
目的 提高對溶血隱祕桿菌緻Lemierre綜閤徵的認識及診治水平.方法 分析1例溶血隱祕桿菌緻Lemierre綜閤徵的臨床特點,併進行文獻複習.結果 患者男,無誘因髮熱伴嚥痛,體檢髮現左側扁桃體充血、腫大,血常規正常,X線胸部正位片未見異常.初步診斷:急性扁桃體炎(左側).予青黴素+阿奇黴素治療後,癥狀加重,查白細胞計數13.59×109/L,中性粒細胞比例0.933,血小闆計數7.4×109/L;TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,血清白蛋白19.3 g/L.血培養結果為溶血隱祕桿菌,改靜脈滴註哌拉西林-他唑巴坦治療後體溫恢複正常.隨後患者齣現左側頸內靜脈血栓形成,予抗凝治療.齣院後2箇月和4箇月時隨訪患者,未見異常.檢索文獻3例,結閤本例共4例,4例患者均為男性,年齡19 ～54歲,均以嚥痛和髮熱為首髮和主要癥狀,均伴有頸部疼痛；嚥炎2例,扁桃體週圍滲齣或膿腫各1例,皮疹2例；血白細胞計數均升高,血小闆計數均下降,肝功能損傷3例,急性腎衰竭2例,急性呼吸衰竭1例；首查X線胸片均正常,病情進展後胸部X線或CT提示雙肺週邊多髮結節高密度影伴空洞形成3例,跼竈或楔形浸潤影1例,胸腔積液1例；血培養結果提示單一溶血隱祕桿菌2例,溶血隱祕桿菌和壞死梭形桿菌複閤感染2例；4例患者均應用青黴素+酶抑製劑治療有效；有血栓者予抗凝治療；無死亡病例.結論 Lemierre綜閤徵臨床特點有原髮口嚥部感染、膿毒血癥、感染性或栓塞性頸靜脈炎及至少一處遠處化膿竈,早期診斷、及時治療可降低溶血隱祕桿菌緻Lemierre綜閤徵病死率.
목적 제고대용혈은비간균치Lemierre종합정적인식급진치수평.방법 분석1례용혈은비간균치Lemierre종합정적림상특점,병진행문헌복습.결과 환자남,무유인발열반인통,체검발현좌측편도체충혈、종대,혈상규정상,X선흉부정위편미견이상.초보진단:급성편도체염(좌측).여청매소+아기매소치료후,증상가중,사백세포계수13.59×109/L,중성립세포비례0.933,혈소판계수7.4×109/L;TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,혈청백단백19.3 g/L.혈배양결과위용혈은비간균,개정맥적주고랍서림-타서파탄치료후체온회복정상.수후환자출현좌측경내정맥혈전형성,여항응치료.출원후2개월화4개월시수방환자,미견이상.검색문헌3례,결합본례공4례,4례환자균위남성,년령19 ～54세,균이인통화발열위수발화주요증상,균반유경부동통；인염2례,편도체주위삼출혹농종각1례,피진2례；혈백세포계수균승고,혈소판계수균하강,간공능손상3례,급성신쇠갈2례,급성호흡쇠갈1례；수사X선흉편균정상,병정진전후흉부X선혹CT제시쌍폐주변다발결절고밀도영반공동형성3례,국조혹설형침윤영1례,흉강적액1례；혈배양결과제시단일용혈은비간균2례,용혈은비간균화배사사형간균복합감염2례；4례환자균응용청매소+매억제제치료유효；유혈전자여항응치료；무사망병례.결론 Lemierre종합정림상특점유원발구인부감염、농독혈증、감염성혹전새성경정맥염급지소일처원처화농조,조기진단、급시치료가강저용혈은비간균치Lemierre종합정병사솔.
Objective To emphasize the importance of the early diagnosis and treatment of Lemierre syndrome caused by Arcanobacterium haemolyticum.Method A case of Lemierre syndrome caused by Arcanobacterium haemolyticum and three similar reported cases were reviewed.Results A man complained of fever with a sore throat,and examination found an enlarged left tonsil with prominent exudate,normal blood routine test and chest radiograph.Although the patient received the treatment of penicillin G and azithromycin,his condition worsened.Blood test showed white blood cell count 13.59 × 109/L (neutrophils 0.933),platelet count 7.4 × 109/L,TBil 54.3 mmol/L,DBil 28.3 mmol/L,AST 127 IU/L,ALT 82 IU/L,serum albumin 19.3 g/L with the development of the conditions.Blood cultures grew Arcanobacterium haemolyticum and the piperacillin-tazobactam was administered until fever was controlled.In addition,anticoagulation was administered when the thrombus was confirmed in the left internal jugular vein.Two follow-up clinic visits over the following 4 months were unremarkable.Besides three similar cases reported,four patients were male,and the ages ranged from 19 to 54 years.The chief complaints were sore throat and fever (4/4),with neck pain (4/4).Physical examinations found pharyngitis (2/4),exudate or abscess in the tonsillar crypt (2/4),maculopapular rashes (2/4).Laboratory results showed leukocytosis and thrombocytopaenia (4/4),acute cholestatic liver dysfunction (3/4),acute renal failure (2/4),acute respiratory failure (1/4).The first chest radiographs were normal at the onset,but chest radiography features included peripheral nodules and cavitation (3/4),focal or wedge-shaped lesions (1/4),pleural effusion (1/4) with the development of the conditions.Blood culture proved that there was only growth of Arcanobacterium haemolyticum (2/4),both Fusobacterium necrophorum and Arcanobacterium haemolyticum were found (2/4).Amoxicillin/clavulanic acid or piperacillin/tazobactam was administered (4/4).Neck CT proved internal jugular vein thrombosis (3/4) and anticoagulation was administered (3/4).All patients recovered and no one died.Conclusions The characters of Lemierre syndrome include primary oropharynx infection,septicaemia,septic or embolic phlebitis of jugular vein,and metastatic abscess.Early recognition and aggressive intravenous broad-spectrum antibiotics are critical to reduce mortality.
