Teo Wan Yee, Chan Mei Yoke, Lam Ching Mei, Chong Chia Yin
Department of Paediatric Medicine, Kandang Kerbau Women's & Children's Hospital, Singapore.
Ann Acad Med Singap. 2006 Dec;35(12):897-900.
Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is a frequent coloniser of fluids used in the hospital setting. It causes infection in immunosuppressed hosts, especially those who are neutropaenic, on chemotherapy and broad spectrum antibiotics. Skin and soft tissue manifestations of Stenotrophomonas maltophilia infection are becoming an increasingly recognised entity; the clinical spectrum ranges from mucocutaneous, skin to soft tissue infections.
We present a case of an 8-year-old girl with acute myeloid leukaemia who developed metastatic skin lesions secondary to Stenotrophomonas maltophilia bacteraemia. The authors reviewed a total of 24 reported cases of mucocutaneous, skin and soft tissue infections by Stenotrophomonas maltophilia. The presentations include metastatic cellulitis, primary cellulitis and infected mucocutaneous ulcers.
This is the first locally reported case of metastatic nodular skin lesions caused by Stenotrophomonas maltophilia bacteraemia. This is also the first reported paediatric case of embolic skin lesions caused by Stenotrophomonas maltophilia. Of the 6 cases of Stenotrophomonas maltophilia bacteraemia seen in the paediatric oncology patients from year 2000 to 2004 at our hospital, only 1 case developed metastatic skin lesions.
Stenotrophomonas maltophilia skin infection should be included into the list of differential diagnoses for metastatic skin lesions in neutropaenic patients, especially with an underlying haematologic malignancy who has received recent chemotherapy and broad spectrum antibiotics. Haematologic malignancy, transplantation, neutropaenic, immunosuppressive therapy and a high severity of illness score were important prognostic factors.
嗜麦芽窄食单胞菌是一种需氧革兰氏阴性杆菌，常定植于医院环境中使用的液体。它可在免疫抑制宿主中引起感染，尤其是那些中性粒细胞减少、正在接受化疗和使用广谱抗生素的患者。嗜麦芽窄食单胞菌感染的皮肤和软组织表现正日益被认识；临床谱包括从黏膜皮肤、皮肤到软组织感染。
我们报告一例8岁急性髓系白血病女孩，她因嗜麦芽窄食单胞菌菌血症继发转移性皮肤病变。作者回顾了总共24例嗜麦芽窄食单胞菌引起的黏膜皮肤、皮肤和软组织感染的报告病例。表现包括转移性蜂窝织炎、原发性蜂窝织炎和感染性黏膜皮肤溃疡。
这是本地首次报告由嗜麦芽窄食单胞菌菌血症引起的转移性结节性皮肤病变病例。这也是首次报告的由嗜麦芽窄食单胞菌引起的栓塞性皮肤病变的儿科病例。在2000年至2004年我院儿科肿瘤患者中所见的6例嗜麦芽窄食单胞菌菌血症病例中，只有1例发生了转移性皮肤病变。
嗜麦芽窄食单胞菌皮肤感染应列入中性粒细胞减少患者转移性皮肤病变的鉴别诊断清单，尤其是患有潜在血液系统恶性肿瘤且近期接受过化疗和广谱抗生素治疗的患者。血液系统恶性肿瘤、移植、中性粒细胞减少、免疫抑制治疗和高疾病严重程度评分是重要的预后因素。
