Mohanty S, Gaind R, Paglietti B, Paul P, Rubino S, Deb M
Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India.
Ann Trop Paediatr. 2010;30(3):233-40. doi: 10.1179/146532810X12786388978760.
An unusual case of bacteraemia with bilateral pleural effusion caused by Salmonella enterica serotype Typhi in a 10-year-old previously healthy girl is reported. The organism was isolated from pleural fluid aspirate and from blood, and exhibited high-level ciprofloxacin resistance (MIC 16 μg/ml) associated with triple mutations in the QRDRs of the gyrA and parC genes leading to the amino-acid changes Ser83→Phe and Asp87→Asn in gyrA and Ser80→Ile in parC. The patient was successfully treated with parenteral ceftriaxone and intercostal chest tube drainage. The case is notable because of the important issue of antimicrobial resistance in S. Typhi and the therapeutic dilemma faced by clinicians regarding the empirical use of ciprofloxacin and newer fluoroquinolones.
报告了一例10岁既往健康女孩由伤寒沙门氏菌血清型伤寒杆菌引起的菌血症伴双侧胸腔积液的罕见病例。该菌株从胸腔积液抽吸物和血液中分离出来，表现出对环丙沙星的高水平耐药性（MIC为16μg/ml），与gyrA和parC基因的喹诺酮耐药决定区（QRDR）中的三重突变相关，导致gyrA中的氨基酸变化Ser83→Phe和Asp87→Asn以及parC中的Ser80→Ile。该患者通过肠外头孢曲松和肋间胸腔闭式引流成功治愈。该病例值得关注，因为伤寒杆菌的抗菌耐药性这一重要问题以及临床医生在经验性使用环丙沙星和新型氟喹诺酮类药物时面临的治疗困境。
