Department of Pharmacy, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Ann Palliat Med. 2021 May;10(5):5780-5785. doi: 10.21037/apm-20-256. Epub 2020 Jul 8.
The extraintestinal infections caused by Yersinia enterocolitica are very rare, especially in the form of spontaneous bloodstream infection at people without history of blood transfusion. Their clinical symptoms and treatments are still not very clear for now. Here, we report a case of spontaneous bloodstream infection caused by Y. enterocolitica in a 56-year-old Chinese male. The patient presented to outpatient with fever for 1 week, he was diagnosed ankylosing spondylitis for 10 years, and suffered from the pain in his neck, lumbosacral region and limbs constantly. After 4 days of outpatient treatment, there was no sign of improvement so he admitted to inpatient department. Ceftriaxone and metronidazole were initiated in the previous 3 days, the temperature did not drop (highest temperature is 38.3 °C) and the limb joint pain was aggravated. On day 4, antibiotic therapy was changed to moxifloxacin as the growth of Y. enterocolitica showed in blood culture, then changed to amikacin and piperacillin/tazobactam according to culture susceptibility. The patient received a total of 24 days antibacterial treatment before discharge, his body temperature returned to normal, but he remains continuous pain in lumbosacral region and limbs after negative blood culture, which was considered to be caused by AS. Gastrointestinal symptoms such as vomiting, diarrhea and abdominal pain were not reported during the hospitalization, which usually appears in patients with Yersinia enterocolitica infection. We reviewed 12 septicemia cases without the history of blood transfusion from the literature. Not all hosts were under a low immunity or have a clear history of exposure. Clinical symptoms and antibiotic agents were also different from case to case. Physicians should consider the rare diagnosis of Y. enterocolitica infection in patients without clear history of exposure and typical symptoms. And distinguish between pain caused by AS and aseptic arthritis caused by Y. enterocolitica.
耶尔森氏菌引起的肠外感染非常罕见，尤其是在无输血史的人群中自发性血流感染的形式。目前，其临床症状和治疗方法仍不是很清楚。在此，我们报告一例 56 岁中国男性因耶尔森氏菌引起的自发性血流感染。患者因发热 1 周就诊于门诊，他被诊断为强直性脊柱炎 10 年，颈、腰及四肢疼痛持续不断。在门诊治疗 4 天后，症状未见改善，遂收入住院。在之前的 3 天中，给予头孢曲松和甲硝唑治疗，体温未下降（最高体温 38.3°C），四肢关节疼痛加重。入院第 4 天，根据血培养结果，将抗生素治疗方案改为莫西沙星，之后根据药敏结果改为阿米卡星和哌拉西林/他唑巴坦。患者共接受 24 天的抗菌治疗后出院，体温恢复正常，但血培养阴性后仍持续出现腰骶部和四肢疼痛，考虑为 AS 所致。住院期间未报告胃肠道症状，如呕吐、腹泻和腹痛，这通常发生在耶尔森氏菌感染患者中。我们从文献中回顾了 12 例无输血史的败血症病例。并非所有宿主都处于低免疫力状态或有明确的暴露史。临床表现和抗生素药物也因病例而异。医生应考虑在无明确暴露史和典型症状的患者中，罕见诊断耶尔森氏菌感染的可能。并区分 AS 引起的疼痛和耶尔森氏菌引起的无菌性关节炎。
