Nagasawa Ryo, Hara Yu, Miyazaki Takuya, Murohashi Kota, Watanabe Hiroki, Kaneko Takeshi
Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Yokohama, Japan.
Respir Med Case Rep. 2020 Aug 27;31:101208. doi: 10.1016/j.rmcr.2020.101208. eCollection 2020.
Ventilator-associated tracheobronchitis (VAT) has been reported to occur in 11% of intubated patients. spp. can cause lower respiratory infections; however, to our knowledge, there have been no reported cases of VAT caused by spp. A 55-year-old man was hospitalized with acute respiratory failure after autologous peripheral blood stem cell transplantation for Hodgkin lymphoma. Chest computed tomography showed diffuse ground-glass opacities in both lung fields. A few days after tracheal intubation, steroid pulse, and antibacterial drugs, the patient's pulmonary involvement temporarily improved. However, these opacities rapidly deteriorated, leading to death about 2 weeks after hospitalization. No significant bacteria other than spp. were detected in sputum cultures during treatment and in blood culture at autopsy. Histological findings revealed tracheitis and diffuse alveolar damage. According to these findings, we diagnosed the patient as having VAT caused by spp. This report suggests that spp. might be an important causative pathogen of VAT in immunodeficient patients who undergo tracheal intubation. Additionally, optimal treatment for spp. must be determined.
据报道，气管插管患者中11%会发生呼吸机相关性气管支气管炎（VAT）。[具体菌种]可引起下呼吸道感染；然而，据我们所知，尚无[具体菌种]引起VAT的病例报道。一名55岁男性因霍奇金淋巴瘤接受自体外周血干细胞移植后，因急性呼吸衰竭住院。胸部计算机断层扫描显示双肺野弥漫性磨玻璃影。气管插管、给予类固醇冲击治疗和抗菌药物治疗几天后，患者的肺部病变暂时改善。然而，这些阴影迅速恶化，导致患者在住院约2周后死亡。治疗期间痰培养及尸检血培养均未检测到除[具体菌种]以外的显著细菌。组织学检查发现气管炎症和弥漫性肺泡损伤。根据这些发现，我们诊断该患者为[具体菌种]引起的VAT。本报告提示，[具体菌种]可能是气管插管免疫缺陷患者VAT的重要致病病原体。此外，必须确定针对[具体菌种]的最佳治疗方法。
