粗糙型脓肿分枝杆菌致播散性皮肤感染
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摘要
报告1例少见的播散性粗糙型脓肿分枝杆菌皮肤感染。患者女,16岁。因四肢播散性红斑、结节,伴反复发热、盗汗及淋巴结增大就诊。皮肤科检查:四肢散在数个暗红色斑,可触及蚕豆至鹌鹑蛋大皮下结节;左膝关节一4 cm×3 cm溃疡面。实验室及辅助检查:血常规中WBC及血红蛋白均下降;左膝关节溃疡分泌物涂片:抗酸染色阳性(++);血平皿培养:表现为粗糙型菌落形态;16S rRNA基因和RNA聚合酶β亚单位rpoB基因序列测定提示为脓肿分枝杆菌。诊断:播散性粗糙型脓肿分枝杆菌皮肤感染。予静脉滴注丁胺卡那霉素及口服克拉霉素治疗1年后痊愈。
A rare case of disseminated cutaneous infection by Mycobacterium abscessus is reported. A 16-year-old girl pre sented with cutaneous erythemas and nodules on the limbs with recurrent fever, night sweats and enlarged lymph nodes. Physical examination showed cutaneous erythemas and pigeon-egg-sized subcutaneous nodules on her limbs and a 3 cm × 4 cm ulcer on the left knee. Laboratory examination showed reductions in both WBC and hemoglobin. Smears of ulcer discharge showed acid-fast bacillus positive(++). Blood cultures displayed a rough morphotype. 16 S rRNA and rpo B gene sequencing analysis confirmed Mycobacterium abscessus as the pathogen. The diagnosis was disseminated cutaneous infection by Mycobacterium abscessus. Patient was cured after one-year treatment with intravenous injection of amikacin and oral clarithromycin.
A rare case of disseminated cutaneous infection by Mycobacterium abscessus is reported. A 16-year-old girl pre sented with cutaneous erythemas and nodules on the limbs with recurrent fever, night sweats and enlarged lymph nodes. Physical examination showed cutaneous erythemas and pigeon-egg-sized subcutaneous nodules on her limbs and a 3 cm × 4 cm ulcer on the left knee. Laboratory examination showed reductions in both WBC and hemoglobin. Smears of ulcer discharge showed acid-fast bacillus positive(++). Blood cultures displayed a rough morphotype. 16 S rRNA and rpo B gene sequencing analysis confirmed Mycobacterium abscessus as the pathogen. The diagnosis was disseminated cutaneous infection by Mycobacterium abscessus. Patient was cured after one-year treatment with intravenous injection of amikacin and oral clarithromycin.
引文
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[10]鄂顺梅,屈平华,黄彬,等.富西亚分枝杆菌从血液与静脉插管中的分离与鉴定[J].检验医学与临床,2012,9(15):1827-1829.
[11]Deshpande D,Srivastava S,Meek C,et al.Ethambutol optimal clinical dose and susceptibility breakpoint identification by use of a novel pharmacokinetic-pharmacodynamic model ofdisseminat ed intracellular Mycobacterium avium[J].Antimicrob Agents Chemother,2010,54(5):1728-1733.
[12]Huang YC,Liu MF,Shen GH,et al.Clinical outcome of Mycobacterium abscessus infection and antimicrobial susceptibility testing[J].J Microbiol Immunol Infect,2010,43(5):401-406.
[2]Daley CL,Griffith DE.Pulmonary disease caused by rapidly grow ing mycobacteria[J].Clin Chest Med,2002,23(3):623-632.
[3]Petrini B.Mycobacterium abscessus:an emerging rapid-growing potential pathogen[J].APMIS,2006,114(5):319-328.
[4]Mueller PS,Edson RS.Disseminated Mycobacterium abscessus infection manifesting as fever of unknown origin and intra-abdominal lymphadenitis:case report and literature review[J].Diagn Microbiol Infect Dis,2001,39(1):33-37.
[5]陈雪,赵亭,孙秋宁,等.脓肿分枝杆菌性皮肤溃疡[J].临床皮肤科杂志,2004,33(6):339-340.
[6]金彦,禚风麟,丁晓岚,等.面部脓肿分枝杆菌感染2例[J].临床皮肤科杂志,2010,39(2):94-96.
[7]J觟nsson B,Ridell M,Wold AE.Phagocytosis and cytokine response to rough and smooth colony variants of Mycobacterium abscessus by human peripheral blood mononuclear cells[J].APMIS,2013,121(1):45-55.
[8]Venketaraman V.Global View of HIV Infection[M]//Cuervo L M M.Infection for Mycobacterium tuberculosis and Nontuberculous Mycobacteria in the HIV/AIDS Patients.Rijeka:In Tech,2011:3-20.
[9]Griffith DE,Aksamit T,Brown-Elliott BA,et al.An official ATS/IDSA statement:diagnosis,treatment,and prevention of nontuberculous mycobacterial diseases[J].Am J Respir Crit Care Med,2007,175(4):367-416.
[10]鄂顺梅,屈平华,黄彬,等.富西亚分枝杆菌从血液与静脉插管中的分离与鉴定[J].检验医学与临床,2012,9(15):1827-1829.
[11]Deshpande D,Srivastava S,Meek C,et al.Ethambutol optimal clinical dose and susceptibility breakpoint identification by use of a novel pharmacokinetic-pharmacodynamic model ofdisseminat ed intracellular Mycobacterium avium[J].Antimicrob Agents Chemother,2010,54(5):1728-1733.
[12]Huang YC,Liu MF,Shen GH,et al.Clinical outcome of Mycobacterium abscessus infection and antimicrobial susceptibility testing[J].J Microbiol Immunol Infect,2010,43(5):401-406.