Ben Ren-Jy, Tsai Yuh-Yuan, Chen Jyh-Ching, Feng Nan-Hsiung
Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Military General Hospital, Kaohsiung, Taiwan, ROC.
J Microbiol Immunol Infect. 2004 Aug;37(4):254-7.
Melioidosis, caused by Burkholderia pseudomallei, has been increasingly recognized in Taiwan recently. Its isolation in liver abscess is rare compared to pulmonary melioidosis. We report a case of liver abscess due to B. pseudomallei in an immunocompetent 27-year-old male soldier admitted due to fever, sore throat and mild non-productive cough for 1 week. Physical examination was unremarkable except for congestion of the pharyngeal wall, moderate enlargement of the tonsils without pus coating, and palpable tender lymphadenopathy over bilateral submental regions. Antibiotic treatment with cefazolin 1 g every 8 hours intravenously was given without response. Left flank pain, followed by right flank pain associated with epigastric tenderness developed. Sonography and computed tomography scan of the abdomen demonstrated liver abscess. Aspiration of the liver abscess was performed and abscess culture yielded B. pseudomallei. Treatment with ceftazidime 2 g every 8 hours intravenously (4 weeks' duration) followed by oral regimens of amoxicillin-clavulanate was given. The patient was free of symptoms at 8 months' follow-up. Early awareness and definite diagnosis as well as institution of proper antimicrobial agents are imperative for successful treatment of melioidosis.
类鼻疽是由伪鼻疽伯克霍尔德菌引起的，近年来在台湾地区的发病率日益增加。与肺类鼻疽相比，其在肝脓肿中的分离情况较为罕见。我们报告一例由伪鼻疽伯克霍尔德菌引起的肝脓肿病例，患者为一名27岁免疫功能正常的男性士兵，因发热、咽痛及轻度干咳1周入院。体格检查除咽壁充血、扁桃体中度肿大无脓苔、双侧颏下区可触及压痛性淋巴结肿大外，无其他异常。给予静脉注射头孢唑林1g每8小时1次的抗生素治疗，但无反应。随后出现左侧腰痛，继之右侧腰痛并伴有上腹部压痛。腹部超声和计算机断层扫描显示肝脓肿。对肝脓肿进行穿刺抽吸，脓肿培养分离出伪鼻疽伯克霍尔德菌。给予静脉注射头孢他啶2g每8小时1次（持续4周），随后口服阿莫西林-克拉维酸治疗方案。患者在随访8个月时无症状。早期认识、明确诊断以及使用适当的抗菌药物对于类鼻疽的成功治疗至关重要。
