心包积液作为土拉弗朗西斯菌感染的唯一表现：一例报告
Pericardial effusion as the only manifestation of infection with Francisella tularensis: a case report.
作者信息
Landais Cécile, Levy Pierre-Yves, Habib Gilbert, Raoult Didier
机构信息
Université de la Méditerranée, Unité des Rickettsies, Faculté de Médecine, Boulevard Jean Moulin, Marseille, France.
出版信息
J Med Case Rep. 2008 Jun 13;2:206. doi: 10.1186/1752-1947-2-206.
INTRODUCTION
Francisella tularensis, a facultative intracellular Gram-negative bacterium, has rarely been reported as an agent of pericarditis, generally described as a complication of tularemia sepsis. F. tularensis is a fastidious organism that grows poorly on standard culture media and diagnosis is usually based on serological tests. However, cross-reactions may occur. Western blotting allows the correct diagnosis.
CASE PRESENTATION
A non-smoking 53-year-old woman was admitted to hospital with a large posterior pericardial effusion. Serological tests showed a seroconversion in antibody titers to F. tularensis (IgG titer = 400) and Legionella pneumophila (IgG titer = 512). F. tularensis was identified by Western immunoblotting following cross-adsorption. The patient reported close contact with rabbits 2 weeks prior to the beginning of symptoms of pericarditis.
CONCLUSION
We report a rare case of pericardial effusion as the only manifestation of infection by F. tularensis. The etiological diagnosis is based on serology. Western blotting and cross-adsorption allow differential diagnosis.
引言
土拉弗朗西斯菌是一种兼性胞内革兰氏阴性菌，很少被报道为心包炎的病原体，通常被描述为兔热病败血症的一种并发症。土拉弗朗西斯菌是一种苛求菌，在标准培养基上生长不良，诊断通常基于血清学检测。然而，可能会发生交叉反应。蛋白质印迹法可实现正确诊断。
病例报告
一名53岁不吸烟女性因大量心包后积液入院。血清学检测显示，其针对土拉弗朗西斯菌（IgG滴度 = 400）和嗜肺军团菌（IgG滴度 = 512）的抗体滴度出现血清转化。经交叉吸附后，通过蛋白质印迹法鉴定出土拉弗朗西斯菌。该患者报告在心包炎症状出现前2周与兔子有过密切接触。
结论
我们报告了一例罕见的以心包积液为土拉弗朗西斯菌感染唯一表现的病例。病因诊断基于血清学。蛋白质印迹法和交叉吸附可实现鉴别诊断。
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