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侵袭性肠胃炎导致昏迷、菌血症、发热和腹泻:一种罕见的危及生命的病症。

Invasive Gastroenteritis Leading to Stupor, Bacteremia, Fever, and Diarrhea: A Rare Life-Threatening Condition.

作者信息

Mehmood Hassan, Marwat Asghar Dil Jan Khan, Khan Noman Ahmed Jang

机构信息

Department of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, PA, USA.

出版信息

J Investig Med High Impact Case Rep. 2017 May 9;5(2):2324709617707978. doi: 10.1177/2324709617707978. eCollection 2017 Apr-Jun.

Abstract

is a gram-positive, rod-shaped organism that can cause serious infections such as meningitis, invasive gastroenteritis, and endocarditis. Every year 1600 people in the United States are affected, with significant mortality of 260 people annually. gastroenteritis has the third highest mortality rate among all the food-borne infection. Invasive listeriosis most commonly affect pregnant women, those in extremes of ages, people with comorbid diseases, and people with weakened immune response. In this article, we present a rare case of invasive gastroenteritis in an 83-year-old female with multiple comorbid conditions and past medical history of type 2 diabetes mellitus and multiple risk factors who was brought to the hospital with altered mental status. She had history of fever, abdominal pain, and watery diarrhea up to 14 episodes in 24 hours for the last 7 days. Her stool culture grew sensitive to penicillin. She was started on penicillin for 2 weeks. She had subsequently complete resolution of fever, diarrhea, and abdominal pain. High index of suspicion is the key to ensure timely initiation of appropriate empirical treatment in the setting of invasive gastroenteritis, especially in people who have high risk factors for listeriosis. We recommend raising awareness in the health care profession about invasive listeriosis in the need of time. Intravenous ampicillin or penicillin G is the treatment of choice, with meropenem as an alternative.

摘要

是一种革兰氏阳性、杆状微生物,可引起严重感染,如脑膜炎、侵袭性肠胃炎和心内膜炎。在美国,每年有1600人受到影响,每年有260人死亡。肠胃炎在所有食源性感染中死亡率排名第三。侵袭性李斯特菌病最常影响孕妇、极端年龄者、患有合并症的人以及免疫反应减弱的人。在本文中,我们报告了一例罕见的侵袭性肠胃炎病例,患者为一名83岁女性,患有多种合并症,既往有2型糖尿病病史及多种危险因素,因精神状态改变入院。在过去7天里,她有发热、腹痛和水样腹泻病史,24小时内腹泻多达14次。她的粪便培养结果显示对青霉素敏感。她开始接受青霉素治疗2周。随后,她的发热、腹泻和腹痛症状完全缓解。高度怀疑是在侵袭性肠胃炎情况下确保及时开始适当经验性治疗的关键,尤其是在有李斯特菌病高风险因素的人群中。我们建议在医疗行业及时提高对侵袭性李斯特菌病的认识。静脉注射氨苄西林或青霉素G是首选治疗方法,美罗培南可作为替代药物。

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