Chung Hsing-Chun, Lee Ching-Tai, Lai Chung-Hsu, Huang Chun-Kai, Lin Jiun-Nong, Liang Shiou-Haur, Lin Hsi-Hsun
Division of Infectious Diseases and Division of Gastroenterology, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taiwan, Republic of China.
Am J Trop Med Hyg. 2008 Sep;79(3):455-7.
Melioidosis is endemic in Taiwan. It is caused by infection with Burkholderia pseudomallei. A prolonged course of oral eradication therapy to avoid relapse after an intensive intravenous therapy is recommended to treat melioidosis. Melioidosis with cardiac involvement is rare and is often combined with septicemia, for which the mortality rate is 20-60%. The initial clinical presentations of melioidosis mimic Mycobacterium tuberculosis infection, which is the most common etiology of bacterial pericarditis in Taiwan. We present a case of non-septicemic melioidosis that presented as non-suppurative cardiac tamponade and left subcarinal lymphadenopathy. Underlying diseases included hepatitis B-related liver cirrhosis and hepatocellular carcinoma. The patient was successfully treated with 2 weeks of intravenous ceftazidime and 12 weeks of oral doxycycline, trimethoprim-sulfamethoxazole, and amoxicillin/clavulanate. Melioidosis-related pericarditis should be considered in the differential diagnoses of bacterial pericarditis in Taiwan.
类鼻疽在台湾为地方性疾病。它由感染伯克霍尔德菌引起。建议在强化静脉治疗后进行长时间的口服根除治疗以避免复发，从而治疗类鼻疽。累及心脏的类鼻疽很罕见，且常合并败血症，其死亡率为20%至60%。类鼻疽的初始临床表现类似结核分枝杆菌感染，而结核分枝杆菌感染是台湾细菌性心包炎最常见的病因。我们报告一例非败血症性类鼻疽病例，该病例表现为非化脓性心脏压塞和左主支气管隆突下淋巴结肿大。基础疾病包括乙型肝炎相关肝硬化和肝细胞癌。该患者通过静脉注射头孢他啶2周以及口服多西环素、甲氧苄啶 - 磺胺甲恶唑和阿莫西林/克拉维酸12周成功治愈。在台湾细菌性心包炎的鉴别诊断中应考虑类鼻疽相关心包炎。
