Swaminathan Neeraja, Aguilar Francisco
Albert Einstein Medical Center, Philadelphia, USA.
Eur J Case Rep Intern Med. 2020 Jul 8;7(10):001741. doi: 10.12890/2020_001741. eCollection 2020.
In this case, a 76-year-old female presented with 3-4 days of fever with no other localizing signs. Notably, she had had an untreated bacteraemia approximately 8 weeks prior to admission. She underwent abdominal imaging which demonstrated a liver abscess and had percutaneous drainage of the same. Blood and pus cultures both grew , which is an unusual organism to be associated with a liver abscess, especially in an immunocompetent host with no risk factors for this condition. Interestingly, this patient did not have any history of dental work, instrumentation, liver function test (LFT) abnormalities and no extrahepatic source for the abscess. This case highlights the importance of having a high index of clinical suspicion for an occult source of infection and emphasizes the importance of following up on cultures even after discharge of a patient, since anaerobic infections such as those caused by can have a largely indolent course.
Fever of unknown aetiology with prior bacteraemia merits a thorough work-up for occult sources such as a localized abscess or malignancy, which can cause bacterial translocation.Fusobacterium and other anaerobic infectious agents should be considered in the context of an indolent disease course since they are slow-growing in cultures, and also, if the patient has risk factors such as immunosuppression, diabetes, poor oral hygiene and so on.It is important to have systems in place in hospitals to ensure follow-up for patients who may have a positive culture after discharge from hospital to confirm that the infection is adequately addressed.
在该病例中，一名76岁女性出现发热3 - 4天，无其他定位体征。值得注意的是，入院前约8周她曾患未经治疗的菌血症。她接受了腹部影像学检查，显示有肝脓肿，并对其进行了经皮引流。血液和脓液培养均生长出[具体细菌名称未给出]，这是一种与肝脓肿相关的不常见微生物，尤其是在无此疾病危险因素的免疫功能正常宿主中。有趣的是，该患者没有任何牙科治疗、器械操作史，肝功能检查（LFT）无异常，且脓肿无肝外来源。该病例强调了对隐匿性感染源保持高度临床怀疑的重要性，并强调即使在患者出院后对培养结果进行随访的重要性，因为诸如由[具体细菌名称未给出]引起的厌氧感染可能具有很大程度的隐匿病程。
有菌血症病史的不明原因发热值得对隐匿性来源如局部脓肿或恶性肿瘤进行全面检查，这些可能导致细菌移位。在隐匿病程的情况下应考虑梭杆菌和其他厌氧感染病原体，因为它们在培养中生长缓慢，并且，如果患者有免疫抑制、糖尿病、口腔卫生差等危险因素也是如此。医院建立相应系统以确保对出院后培养结果可能为阳性的患者进行随访，以确认感染得到充分处理非常重要。
