Emergency Unit and Critical Care Center, Tsuyama Central Hospital, 1756 Kawasaki, Tsuyama, Okayama, Japan.
J Infect Chemother. 2013 Apr;19(2):338-41. doi: 10.1007/s10156-012-0472-x. Epub 2012 Sep 20.
A 46-year-old woman was transferred to our emergency unit because of impaired consciousness and respiratory failure with the history of excessive pesticide intake. The patient was hypersalivative and had bilateral pupillary miosis. Laboratory results showed markedly decreased cholinesterase. She was intubated and treated in the intensive care unit with the diagnosis of organophosphorus poisoning. The patient had persisted diarrhea, with a high fever and stomach tenderness on day 10. Whole-body contrast enhanced computed tomography revealed a swollen, enhanced small intestinal wall, and blood culture identified Delftia acidovorans. She was diagnosed as D. acidovorans bacteremia, probably caused by bacterial translocation based on the clinical presentation and the exclusion of other sources, and treated well with a total of 8 days of antibiotic therapy. So far as we know, this is the first case of D. acidovorans bacteremia that was presumably caused by bacterial translocation after organophosphorus poisoning in an immunocompetent adult patient.
一位 46 岁女性因意识障碍和呼吸衰竭转入我院急诊,有过量农药摄入史。患者流涎过多,双侧瞳孔缩小。实验室检查结果显示胆碱酯酶明显降低。患者转入重症监护病房进行气管插管和治疗,诊断为有机磷中毒。患者第 10 天持续腹泻,高热,上腹痛。全腹部增强 CT 显示小肠壁肿胀、强化,血培养鉴定出德氏酸菌。根据临床表现和排除其他来源,患者被诊断为德氏酸菌菌血症,可能是细菌易位所致,经 8 天的抗生素治疗后痊愈。据我们所知,这是首例免疫功能正常的成人患者在有机磷中毒后发生细菌易位导致的德氏酸菌菌血症。