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需要手术干预的小儿口咽型兔热病

Paediatric oropharyngeal tularaemia requiring surgical intervention.

作者信息

Nemmour Amina, Bakri Adzreil, Fischer Claude A, Brand Yves

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Graubunden, Chur, Switzerland.

Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur, Malaysia.

出版信息

BMJ Case Rep. 2019 Sep 6;12(9):e229754. doi: 10.1136/bcr-2019-229754.

Abstract

Tularaemia is a rare infectious disease endemic in most European countries caused by the bacterium Patients often show acute non-specific symptoms, which causes a delay in diagnosis and proper treatment, potentially resulting in significant morbidities such as deep neck abscess, meningitis, endocarditis and septic shock. The authors present a case of a 5-year old boy with a 4-day history of fever, sore throat and painful cervical lymphadenopathy, whose clinical progression worsened despite being treated with recommended antibiotics as per WHO guidelines once the diagnosis of Tularaemia was confirmed by serologic tests. He developed a parapharyngeal abscess and a persistent left necrotic cervical lymph node, which both were surgically drained and excised, respectively, and an extended course of antibiotic was given. Subsequently, the patient fully recovered from the illness and the follow-up was negative for relapse.

摘要

兔热病是一种在大多数欧洲国家流行的罕见传染病,由细菌引起。患者常表现出急性非特异性症状,这导致诊断和适当治疗的延迟,可能会引发严重的发病情况,如深部颈部脓肿、脑膜炎、心内膜炎和感染性休克。作者报告了一例5岁男孩的病例,该男孩有4天的发热、咽痛和颈部疼痛性淋巴结病病史,尽管根据世界卫生组织指南使用推荐抗生素进行治疗,但在血清学检测确诊兔热病后,其临床病情仍恶化。他出现了咽旁脓肿和持续的左侧坏死性颈部淋巴结,分别对二者进行了手术引流和切除,并给予了延长疗程的抗生素治疗。随后,患者完全康复,随访未发现复发。

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本文引用的文献

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Treatment-failure tularemia in children.儿童兔热病治疗失败
Korean J Pediatr. 2018 Feb;61(2):49-52. doi: 10.3345/kjp.2018.61.2.49. Epub 2018 Feb 28.
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The status of tularemia in Europe in a one-health context: a review.“同一健康”背景下欧洲兔热病的现状:综述
Epidemiol Infect. 2015 Jul;143(10):2137-60. doi: 10.1017/S0950268814002398. Epub 2014 Sep 30.
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Tularemia in central Anatolia.安纳托利亚中部的土拉菌病。
Infection. 2013 Apr;41(2):391-9. doi: 10.1007/s15010-012-0355-1. Epub 2012 Oct 27.
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Tularemia: a rare cause of neck mass, evaluation of 33 patients.土拉热:一种罕见的颈部肿块病因,33 例患者评估。
Eur Arch Otorhinolaryngol. 2011 Dec;268(12):1699-704. doi: 10.1007/s00405-011-1722-8. Epub 2011 Aug 4.

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