Service de Médecine Interne, Maladies Infectieuses et Immunologie Clinique, Hôpital Robert Debré, Avenue Général Koenig, 51100, Reims, France.
Laboratoire de Bactériologie, Hôpital Robert Debré, Avenue Général Koenig, 51100, Reims, France.
BMC Ophthalmol. 2015 Mar 8;15:21. doi: 10.1186/s12886-015-0002-6.
The rare descriptions, in the literature, of ocular infections due to Pasteurella multocida include: endophtalmitis, keratitis and corneal ulcers, Parinaud's oculoglandular syndrome, and conjunctivitis. Here, we report a rare case of rapidly evolving conjunctivitis due to Pasteurella multocida, occurring after direct inoculation with animal droplets in an immuno-compromised host.
A 69-year-old, Caucasian male was referred to our department with purulent conjunctivitis, occurring five days after chemotherapy for an angioimmunoblastic-T-cell-lymphoma, and thirty-three hours after being struck in his right eye by his sneezing Dachshund dog. Physical examination revealed purulent conjunctivitis of the right eye associated with inflammatory edema of both lids. Direct bacteriological examination of conjunctival secretions showed gram-negative bacilli and regular, grey non-hemolytic colonies appearing the next day on blood agar. The oxidase test was positive for these colonies. An antibiotherapy associating intravenous amoxicillin and amoxicillin/clavulanate was administered. The outcome was favorable in the next three days allowing discharge of the patient with amoxicillin (2 g tid per os).
This case report may be of interest for infectious diseases, ophthalmology or oncology specialists, especially nowadays with chemotherapy being administered in day care centres, where unusual home pathogens can be encountered in health related infections. In this case, previous animal contact and conjunctival samples showing Enterobacteriaceae like colonies with positive oxidase test were two important clues which could help clinicians to make the diagnosis of Pasteurella conjunctivitis in every day practice.
文献中罕见描述的多杀巴斯德菌引起的眼部感染包括：眼内炎、角膜炎和角膜溃疡、Parinaud 眼-腺综合征和结膜炎。在此，我们报告一例免疫功能低下宿主因直接接种动物飞沫而发生的多杀巴斯德菌引起的快速进展性结膜炎的罕见病例。
一名 69 岁白人男性因化疗后免疫抑制的情况下，于急性血管免疫母细胞性 T 细胞淋巴瘤后 5 天，右眼被打喷嚏的达克斯猎犬击中后 33 小时，出现脓性结膜炎，被转至我科。体格检查发现右眼脓性结膜炎伴有双眼睑炎性水肿。直接对结膜分泌物进行细菌学检查显示革兰氏阴性杆菌和次日在血琼脂上出现规则、灰色非溶血性菌落。这些菌落的氧化酶试验阳性。给予静脉注射阿莫西林和阿莫西林/克拉维酸联合抗生素治疗。在接下来的 3 天内，患者的病情有所改善，出院时口服阿莫西林（2 g tid）。
该病例报告可能对传染病、眼科或肿瘤学专家感兴趣，尤其是如今化疗在日间护理中心进行，在这些地方可能会遇到不常见的家庭病原体，导致与健康相关的感染。在这种情况下，先前的动物接触和结膜样本显示具有阳性氧化酶试验的肠杆菌科样菌落，这是两个重要线索，可以帮助临床医生在日常实践中诊断出结膜炎。
