Plague Unit- Institut Pasteur de Madagascar, BP1274 Ambatofotsikely, 101, Antananarivo, Madagascar.
Department of Infectious Hazard Management, World Health Organization, Avenue Appia 20, CH-1211, 27, Geneva, Switzerland.
BMC Pulm Med. 2018 May 29;18(1):92. doi: 10.1186/s12890-018-0656-y.
Plague is a life-threatening disease caused by the bacterium, Yersinia pestis. Madagascar is the leading country for human plague cases worldwide. Human plague is a serious disease, particularly in its septicaemic and pneumonic forms. We report a case of pneumonic plague co-infected by a MDR-Stenotrophomonas maltophilia.
A 24 year-old man originated from Soavinandriana, a plague focus, felt uneasy and developed high fever with chills. He started treatment by himself, by private medical care and by a traditional healer for nine days moving several times from place to place. His condition had deteriorated when he presented to a district hospital with a syndrome of dyspnea, bronchial rale and altered state of consciousness. Two days later, plague diagnosis, performed as a last resort, revealed a positive F1 antigen on rapid diagnostic test. Additional tests (pla PCR and plague serology) evidenced a Y. pestis infection. However, streptomycin treatment did not achieve a complete recovery as the course of disease was complicated by the presence of MDR-S. maltophilia in his lung. This opportunistic infection could have been favored by an immunosuppression due to Y. pestis pulmonary infection and probably been acquired during his stay at a District Hospital. He was treated with a combination of ciprofloxacin and gentamycin and recovered fully.
Pneumonic plague infection may promote another virulent or avirulent bacterial infection particularly when it is not initially suspected. However, coinfection is rarely described and its occurrence frequency is unknown. In middle or low resources areas, which is the case of most plague endemic countries, control and prevention of infections in health facilities is not optimal. Co-infection with an opportunistic pathogen agent, such as S. maltophilia, is a risk which must not be disregarded as demonstrated by this case report. When deciding of a national control strategy, it should be taken into account in the choice of the first line treatment.
鼠疫是一种由鼠疫耶尔森菌引起的危及生命的疾病。马达加斯加是世界上人间鼠疫病例最多的国家。人间鼠疫是一种严重的疾病，特别是在败血型和肺鼠疫形式下。我们报告了一例由多重耐药嗜麦芽窄食单胞菌合并感染的肺鼠疫病例。
一名 24 岁的男性来自鼠疫流行地区的索瓦里诺，感到不适并出现高热寒战。他自行治疗，在私人医疗机构和传统治疗师那里治疗了九天，其间多次搬离。当他因呼吸困难、支气管啰音和意识改变综合征而到区医院就诊时，病情恶化。两天后，作为最后手段进行的鼠疫诊断显示快速诊断检测的 F1 抗原阳性。进一步的检测（pla PCR 和鼠疫血清学）证实存在鼠疫耶尔森菌感染。然而，由于疾病过程中并发了肺部的多重耐药嗜麦芽窄食单胞菌感染，链霉素治疗并未完全恢复。这种机会性感染可能是由于鼠疫耶尔森菌肺部感染导致的免疫抑制引起的，可能是在他住院期间获得的。他接受了环丙沙星和庆大霉素联合治疗，并完全康复。
肺鼠疫感染可能会促进另一种毒力或非毒力细菌感染，特别是在最初未被怀疑时。然而，合并感染很少被描述，其发生频率尚不清楚。在中低资源地区，即大多数鼠疫流行国家的情况，卫生机构的感染控制和预防措施并不理想。在这种情况下，如嗜麦芽窄食单胞菌等机会性病原体的合并感染是一个不容忽视的风险，正如本病例报告所证明的那样。在制定国家控制策略时，应考虑在选择一线治疗时将其纳入考虑。
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