Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA.
J Investig Med High Impact Case Rep. 2020 Jan-Dec;8:2324709620926900. doi: 10.1177/2324709620926900.
A 78-year-old male, originally from China, was brought to the hospital for weakness, urinary incontinence, confusion, and poor oral intake. He was started on empiric antibiotics, which were narrowed when blood cultures produced gram-negative bacteremia speciating to , sensitive to ceftriaxone. Computed tomography scan of the abdomen and pelvis demonstrated a large cystic region with air-fluid level in the left lobe of the liver. Suspecting this to be the source of the patient's bacteremia, the lesion was percutaneously drained and the fluid cultured, which also revealed ceftriaxone-sensitive . While a stool ova and parasite examination on the patient was negative, further workup was positive for antibody in the serum, detected via enzyme-linked immunosorbent assay and indicative of either current or past infection. This suggested possible prolonged subclinical infection with bacterial superinfection, especially given that is one of the most common organisms cultured from these abscesses. In patients with liver abscesses who immigrated from developing and/or endemic regions or have a relevant recent travel history, an underlying amoebic etiology of an abscess should be considered.
一位 78 岁男性，原籍中国，因乏力、尿失禁、意识混乱和摄食差而被送往医院。他开始接受经验性抗生素治疗，当血液培养出革兰氏阴性菌并鉴定为 、对头孢曲松敏感时，抗生素被缩小了范围。腹部和骨盆的计算机断层扫描显示左肝叶有一个大的囊状区域，伴有气液平面。由于怀疑这是患者菌血症的来源，对病变进行了经皮引流和液体培养，结果也显示头孢曲松敏感的 。虽然患者的粪便寄生虫检查为阴性，但进一步的检查结果显示血清中存在 抗体，通过酶联免疫吸附试验检测到，提示当前或过去的感染。这表明可能存在细菌感染的长期亚临床感染，特别是因为 是从这些脓肿中培养出来的最常见的生物体之一。对于来自发展中和/或流行地区或有相关近期旅行史的肝脓肿患者，应考虑脓肿的潜在阿米巴病因。
