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慢性肾脏病患者并发播散性类鼻疽菌病合并心内膜炎的管理挑战

Challenges in Management of Disseminated Melioidosis with Endocarditis in a Patient with Chronic Kidney Disease.

作者信息

Krishnamoorthy Adhiti, Fernando Edwin, Dorairaj Prabhakar, Thimmaiah Akshith, Kumar D Suresh

机构信息

Department of Internal Medicine, Mehta Multispecialty Hospital Pvt. Ltd., Chennai, Tamil Nadu, India.

Department of Nephrology, Mehta Multispecialty Hospital Pvt. Ltd., Chennai, Tamil Nadu, India.

出版信息

Indian J Nephrol. 2020 Nov-Dec;30(6):416-419. doi: 10.4103/ijn.IJN_185_19. Epub 2020 Oct 9.

DOI:10.4103/ijn.IJN_185_19
PMID:33840962
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8023022/
Abstract

Melioidosis is a tropical infection that is increasingly being reported from South India. It is frequently observed in patients with diabetes mellitus, chronic ethanol consumption and chronic kidney disease (CKD). It presents commonly with pneumonia, deep seated abscesses or osteoarticular infections. Cardiac complications are very rare with endocarditis being reported in very few patients. We report the first case of endocarditis in melioidosis in India. Although infections are common in patients with CKD, melioidosis at the time of diagnosis of CKD has never been reported in the past. Our patient had multiple liver abscesses and endocarditis, and responded well to a 6 week course of ceftazidime and doxycycline, with the latter being continued for 20 weeks.

摘要

类鼻疽是一种热带感染病，在印度南部的报告越来越多。糖尿病、长期酗酒和慢性肾脏病（CKD）患者中经常观察到这种病。它通常表现为肺炎、深部脓肿或骨关节炎感染。心脏并发症非常罕见，仅有极少数患者报告患心内膜炎。我们报告了印度首例类鼻疽性心内膜炎病例。虽然感染在CKD患者中很常见，但过去从未报告过在CKD诊断时患类鼻疽的情况。我们的患者有多个肝脓肿和心内膜炎，接受了为期6周的头孢他啶和强力霉素治疗，效果良好，后者持续使用了20周。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/b84314db928b/IJN-30-416-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/99b84a65bdfa/IJN-30-416-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/c92e4f8cf9cc/IJN-30-416-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/b84314db928b/IJN-30-416-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/99b84a65bdfa/IJN-30-416-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/c92e4f8cf9cc/IJN-30-416-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1baf/8023022/b84314db928b/IJN-30-416-g003.jpg

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本文引用的文献

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Melioidosis: an unusual cause of infective endocarditis: a case report.类鼻疽：感染性心内膜炎的罕见病因：一例报告
Eur Heart J Case Rep. 2018 May 2;2(2):yty055. doi: 10.1093/ehjcr/yty055. eCollection 2018 Jun.
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Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India.印度类鼻疽病例的临床表现、抗菌药物药敏模式和转归。
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Trop Med Infect Dis. 2018 May 22;3(2):51. doi: 10.3390/tropicalmed3020051.
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Ceylon Med J. 2016 Dec 30;61(4):192-193. doi: 10.4038/cmj.v61i4.8390.
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Melioidosis :an emerging infection in India.类鼻疽：印度一种新出现的感染病。
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Risk factors for recurrent melioidosis in northeast Thailand.泰国东北部类鼻疽复发的危险因素。
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Melioidosis: epidemiology, pathophysiology, and management.类鼻疽病：流行病学、病理生理学及管理
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