Spiliopoulou Anastasia, Assimakopoulos Stelios F, Foka Antigoni, Kolonitsiou Fevronia, Lagadinou Maria, Petinaki Efthimia, Anastassiou Evangelos D, Spiliopoulou Iris, Marangos Markos
Department of Microbiology, University General Hospital of Patras, Ippokratous 1, Rion 26504 Patras, Greece.
J Med Case Rep. 2014 Dec 13;8:423. doi: 10.1186/1752-1947-8-423.
Patients with human immunodeficiency virus carry a significant risk of contracting opportunistic infections. The worldwide increased incidence of tuberculosis has instituted pulmonary tuberculosis as an important diagnostic consideration in patients with human immunodeficiency virus presenting with lower respiratory tract infection. A positive result on the readily-available Ziehl-Neelsen stain usually leads to the initiation of antituberculous treatment, since tuberculosis may exert a rapid and even fatal clinical progress in human immunodeficiency virus coinfection. However, a number of other acid-fast bacteria might be implicated as offending pathogens. This case highlights the importance of broadening the list of pathogens that can account for a positive Ziehl-Neelsen stain in this select group of patients.
We describe the case of a 34-year-old, Albanian man with untreated human immunodeficiency virus, presenting with clinical and radiologic signs of pulmonary tuberculosis and a positive Ziehl-Neelsen sputum specimen, who was finally diagnosed with pulmonary infection by Rhodococcus equi.
Rhodococcus equi is a rare cause of pulmonary disease, even in patients with human immunodeficiency virus, and a positive Ziehl-Neelsen sputum specimen often misleads clinicians to more common organisms such as mycobacteria. A high index of suspicion, broadening the spectrum of optional pathogens, and effective communication between clinicians and microbiologists can ensure an efficient diagnostic and therapeutic approach.
感染人类免疫缺陷病毒的患者极易感染机会性感染。全球范围内结核病发病率的上升使肺结核成为出现下呼吸道感染的人类免疫缺陷病毒患者的重要诊断考虑因素。由于在人类免疫缺陷病毒合并感染中结核病可能会导致迅速甚至致命的临床进展，因此，易于获得的萋-尼氏染色结果呈阳性通常会促使开始抗结核治疗。然而，一些其他抗酸菌也可能是致病病原体。本病例强调了在这类特定患者群体中扩大可导致萋-尼氏染色呈阳性的病原体种类的重要性。
我们描述了一名34岁的阿尔巴尼亚男子的病例，该男子未接受过人类免疫缺陷病毒治疗，出现了肺结核的临床和影像学症状，痰涂片萋-尼氏染色呈阳性，最终被诊断为马红球菌肺部感染。
马红球菌是肺部疾病的罕见病因，即使在感染人类免疫缺陷病毒的患者中也是如此，痰涂片萋-尼氏染色呈阳性常常会使临床医生误将其诊断为更常见的病原体，如分枝杆菌。高度的怀疑指数、拓宽可选病原体的范围以及临床医生与微生物学家之间的有效沟通可确保采取有效的诊断和治疗方法。
