Khavari P A, Bolognia J L, Eisen R, Edberg S C, Grimshaw S C, Shapiro P E
Department of Dermatology, Yale University School of Medicine, New Haven, Conn 06510.
Arch Dermatol. 1991 Apr;127(4):543-6.
Primary cutaneous Bacillus cereus infection frequently presents as a single necrotic bulla on the extremity of an immunocompromised patient. In lesional biopsy specimens and smears, the large gram-positive rods of B cereus may be mistaken for Clostridium species. This is a potentially serious error, as Bacillus species are resistant to penicillin and other beta-lactam antibiotics. We studied a case in which large periodic acid-Schiff-staining organisms were seen in the biopsy specimen from a necrotic bulla on the finger of a neutropenic patient with diffuse large cell lymphoma. The tissue biopsy specimen subsequently yielded a pure culture of B cereus. Staining with periodic acid-Schiff was then performed on a series of bacterial species in human tissue and from smears of culture colonies. The following bacterial species were found to be consistently periodic acid-Schiff positive after diastase digestion: B cereus, Corynebacterium diphtheriae, Propionibacterium acnes, Klebsiella pneumoniae, and Micrococcus luteus.
原发性皮肤蜡样芽孢杆菌感染在免疫功能低下患者的肢体上常表现为单个坏死性大疱。在病变活检标本和涂片检查中，蜡样芽孢杆菌的革兰氏阳性大杆菌可能会被误诊为梭菌属。这是一个潜在的严重错误，因为芽孢杆菌属对青霉素和其他β-内酰胺类抗生素耐药。我们研究了一例病例，在一名患有弥漫性大细胞淋巴瘤的中性粒细胞减少患者手指上的坏死性大疱活检标本中发现了大量过碘酸-希夫染色阳性的微生物。随后，该组织活检标本培养出了纯蜡样芽孢杆菌。然后对人体组织中的一系列细菌种类以及培养菌落涂片进行过碘酸-希夫染色。发现以下细菌种类在淀粉酶消化后始终呈过碘酸-希夫染色阳性：蜡样芽孢杆菌、白喉棒状杆菌、痤疮丙酸杆菌、肺炎克雷伯菌和藤黄微球菌。
