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一名低丙种球蛋白血症患者复发性空肠弯曲菌菌血症:病例报告

Recurrent Campylobacter jejuni bacteremia in a patient with hypogammaglobulinemia: A case report.

作者信息

Kim Youie, Shin Ju Ae, Han Seung Beom, Cho Bin, Jeong Dae Chul, Kang Jin Han

机构信息

Department of Pediatrics The Vaccine Bio Research Institute The Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Medicine (Baltimore). 2017 Jun;96(25):e7238. doi: 10.1097/MD.0000000000007238.

Abstract

RATIONALE

Although some cases of recurrent bacteremia due to Campylobacter jejuni have been reported in immunocompromised patients, antibiotic treatment strategies to eradicate C. jejuni and prevent recurrent infections in immunocompromised patients have not been established. Authors' experience of such rare cases should be shared for improving patients' outcomes.

PATIENT CONCERNS

An 18-year-old boy with hypogammaglobulinemia, who received intravenous immunoglobulin replacement therapy every 3 weeks, was admitted to hospital repeatedly due to recurrent diarrhea and cellulitis of the leg.

DIAGNOSES

The patient was admitted 6 times, and among them, C. jejuni was isolated from blood cultures 4 times and stool cultures 2 times.

INTERVENTIONS

The patient experienced recurrent C. jejuni enteritis and bacteremia 5 times despite macrolide therapy. Doxycycline was administered for 3 months after the fifth admission.

OUTCOMES

Ten months after the completion of doxycycline therapy for 3 months, C. jejuni enteritis relapsed; however, since then, recurrent infection has not occurred for 10 months.

LESSONS

Immunocompromised patients can experience recurrent C. jejuni infection despite prolonged antibiotic therapy. Further studies to establish appropriate antibiotic therapy for eradicating colonized C. jejuni and preventing recurrent infection are needed.

摘要

理论依据

尽管免疫功能低下患者中已报告了一些空肠弯曲菌引起的复发性菌血症病例,但尚未确立根除空肠弯曲菌并预防免疫功能低下患者反复感染的抗生素治疗策略。应分享此类罕见病例的作者经验,以改善患者预后。

患者情况

一名18岁患有低丙种球蛋白血症的男孩,每3周接受一次静脉注射免疫球蛋白替代治疗,因反复腹泻和腿部蜂窝织炎多次入院。

诊断

患者入院6次,其中4次血培养和2次粪便培养分离出空肠弯曲菌。

干预措施

尽管接受了大环内酯类治疗,患者仍5次发生空肠弯曲菌复发性肠炎和菌血症。第五次入院后给予强力霉素治疗3个月。

结果

强力霉素治疗3个月结束后10个月,空肠弯曲菌肠炎复发;然而,从那时起,10个月内未再发生反复感染。

经验教训

尽管进行了长期抗生素治疗,免疫功能低下患者仍可能发生空肠弯曲菌反复感染。需要进一步研究以确立根除定植的空肠弯曲菌并预防反复感染的适当抗生素治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d34f/5484231/68343653fe4f/medi-96-e7238-g001.jpg

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