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咬伤伤口后的感染:例如由念珠状链杆菌引起的鼠咬热。

[Infections after bite wounds : For example rat bite fever due to Streptobacillus moniliformis].

作者信息

Hof Herbert, Binder Rudolf, Schäfer Christian, Stuber Madeleine, Licht Andreas, Bozenhardt-Stavrakidis Iris, Bode Konrad

机构信息

Labor, SLK Kliniken, Am Gesundbrunnen 20-26, 74078, Heilbronn, Deutschland.

SLK Kliniken, Am Plattenwald 1, 74177, Bad Friedrichshall, Deutschland.

出版信息

Unfallchirurg. 2018 Sep;121(9):764-768. doi: 10.1007/s00113-018-0493-8.

Abstract

Rat bite fever due to Streptobacillus moniliformis induces typical but not pathognomonic clinical signs, such as local purulent wound infection followed by maculopapular exanthema, myalgia as well as purulent joint infections. Severe complications, such as osteomyelitis and endocarditis are possible. it seems that this infection is rarely diagnosed but this infection could be much more common because the final diagnostic proof is difficult to achieve. Firstly, the culture of these bacteria is critical because the bacteria are fastidious and secondly the exact differentiation of the isolates is hardly possible by standard laboratory methods. Modern techniques such as mass spectroscopy (MALDI-TOF) and molecular biology allow a precise clarification. Surgical cleansing of infection sites in combination with a rational antibiotic therapy, for example with beta-lactam antibiotics, are generally able to cure the infection if treatment is started early enough. In addition, vaccinations, for example against tetanus and rabies have to be considered in this situation as for all other bite wound infections.

摘要

由念珠状链杆菌引起的鼠咬热会引发典型但不具有诊断特异性的临床症状,如局部化脓性伤口感染,随后出现斑丘疹、肌痛以及化脓性关节感染。严重的并发症,如骨髓炎和心内膜炎也有可能发生。这种感染似乎很少被诊断出来,但实际上可能更为常见,因为很难获得最终的诊断依据。首先,这些细菌的培养至关重要,因为它们对营养要求苛刻;其次,通过标准实验室方法很难准确鉴别分离出的菌株。诸如质谱分析(基质辅助激光解吸电离飞行时间质谱)和分子生物学等现代技术能够实现精确的鉴定。如果尽早开始治疗,对感染部位进行手术清创并结合合理的抗生素治疗,例如使用β-内酰胺类抗生素,通常能够治愈感染。此外,与所有其他咬伤伤口感染情况一样,在这种情况下还必须考虑接种疫苗,如破伤风疫苗和狂犬病疫苗。

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