Macleod C K, Khokhar F A, Warne B, Wick R, Butcher R, Cassimon B, Hayden P, Holt K, Török M E
Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK.
Medway Maritime Hospital, Gillingham, Kent, UK.
Case Rep Infect Dis. 2021 Apr 28;2021:6638780. doi: 10.1155/2021/6638780. eCollection 2021.
Hypervirulent causes severe disseminated infections, typically with hepatic and central nervous system involvement including endophthalmitis. . We report a fatal case of an undocumented Chinese migrant in her 60s who presented to the emergency department with abdominal pain, lethargy, and headache over the preceding two weeks. She had a new diagnosis of diabetes mellitus on admission. Computed tomography scan of the thorax, abdomen, and pelvis showed bilateral pneumonia with liver abscesses. The patient was treated with empirical broad-spectrum antibiotics before was isolated from cerebrospinal fluid and blood cultures. The isolate was further characterised as a ST23 (ST: sequence type), serotype K1 hypervirulent strain using Nanopore sequencing. Despite admission to the intensive care unit, the patient died within 48 hrs of admission.
This case demonstrates the need for increased awareness of hypervirulent , even in countries where it occurs infrequently. Novel, rapid, sequencing technologies can support diagnosis in unusual presentations.
高毒力菌株可引发严重的播散性感染，通常累及肝脏和中枢神经系统，包括眼内炎。我们报告一例60多岁身份不明的中国移民的致命病例，她在过去两周内出现腹痛、嗜睡和头痛，并前往急诊科就诊。入院时她被新诊断为糖尿病。胸部、腹部和骨盆的计算机断层扫描显示双侧肺炎伴肝脓肿。在从脑脊液和血培养中分离出该菌株之前，患者接受了经验性广谱抗生素治疗。使用纳米孔测序进一步将分离株鉴定为ST23（ST：序列类型）、血清型K1高毒力菌株。尽管入住了重症监护病房，但患者在入院后48小时内死亡。
该病例表明，即使在高毒力菌株罕见出现的国家，也需要提高对其的认识。新型快速测序技术可支持对不寻常表现的诊断。
