Pumpradit Wadchara, Ariyoshi Koya, Petkanchanapong Wimol, Wichukchinda Nuanjun, Chaiprasert Angkana, Rojanawat Archawin, Sawanpanyalert Pathom, Pathipvanich Panita
JICA-NIH Project, Ministry of Public Health, Thailand.
Asian Pac J Allergy Immunol. 2006 Dec;24(4):239-43.
A 29 year old HIV positive Thai female with CD4 count of 10 cells/mm3 presented with chronic diffuse abdominal pain, fever, weight loss, anemia and leucopenia. Ultrasonography demonstrated diffuse upper abdominal lymphadenopathy with ascites. Microbiological and molecular work up of the specimen obtained by ultrasound-guided lymph node aspiration revealed co-infection with Burkholderia pseudomallei and Mycobacterium avium. Indirect hemagglutination, IgM-indirect fluorescent antibody, and IgG-indirect fluorescent antibody to Burkholderia pseudomallei were < 1:20, < 1:50 and < 1:50, respectively, at nine months, four months before the culture diagnosis and two months, eight months after the culture diagnosis of Burkholderia pseudomallei infection. The patient was treated initially with two weeks of intravenous ceftazidime, followed by oral cotrimoxazole, doxycycline and chloramphenicol. Clarithromycin and ofloxacin were added after the identification of Mycobacterium avium and its susceptibility test. The patients demonstrated clinical improvement with decreasing abdominal pain and resolution of fever.
一名29岁的泰国女性，HIV阳性，CD4细胞计数为10个/mm³，出现慢性弥漫性腹痛、发热、体重减轻、贫血和白细胞减少。超声检查显示上腹部弥漫性淋巴结肿大并伴有腹水。对超声引导下淋巴结穿刺获取的标本进行微生物学和分子学检查，发现同时感染了伯克霍尔德菌和鸟分枝杆菌。在伯克霍尔德菌感染培养诊断前四个月、诊断九个月时以及诊断后两个月、八个月时，针对伯克霍尔德菌的间接血凝试验、IgM间接荧光抗体试验和IgG间接荧光抗体试验结果分别为<1:20、<1:50和<1:50。患者最初接受了两周的静脉注射头孢他啶治疗，随后口服复方新诺明、强力霉素和氯霉素。在鉴定出鸟分枝杆菌并进行药敏试验后，加用了克拉霉素和氧氟沙星。患者临床症状改善，腹痛减轻，发热消退。
