Department of Anesthesiology, Kitasato University, School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara City, Kanagawa, 252-0375, Japan.
Division of Intensive Care Medicine, Department of Research and Development Center for New Medical Frontiers, Kitasato University, School of Medicine, 1-15-1 Kitasato Minami-ku, Sagamihara City, Kanagawa, 252-0375, Japan.
J Anesth. 2022 Jun;36(3):428-431. doi: 10.1007/s00540-022-03057-4. Epub 2022 Mar 23.
Pasteurella is a gram-negative coccobacillus that is commonly transmitted through cat and dog bites and causes various diseases in humans. In the present case, kissing an animal caused Pasteurella multocida infection, leading to sepsis and cardiogenic shock. We used venoarterial extracorporeal membrane oxygenation (VA-ECMO) to support the cardiovascular system until recovery. A 62-year-old man with no relevant history was referred to our hospital with a 1-day history of sore throat and fever. He was diagnosed with cervical cellulitis and later developed septic shock, which necessitated catecholamine administration and intubation. It was subsequently revealed that the patient had Pasteurella multocida bacteremia and kept a pet dog at home. In addition to sepsis, the patient experienced refractory cardiogenic shock and was unresponsive to medical treatment; therefore, VA-ECMO was initiated. After its introduction, the patient's hemodynamic status improved, and he was weaned from extracorporeal circulation after 6 days. He was discharged home and resumed his former life 50 days later. Pasteurella multocida infection can cause sepsis followed by severe cardiac dysfunction in healthy adults. Therefore, VA-ECMO may be a useful treatment option in patients with sepsis-induced myocardial dysfunction and refractory cardiogenic shock.
巴斯德氏菌是一种革兰氏阴性球杆菌,通常通过猫和狗咬伤传播,可导致人类发生各种疾病。在本病例中,亲吻动物导致多杀巴斯德氏菌感染,引起脓毒症和心源性休克。我们使用静脉-动脉体外膜肺氧合(VA-ECMO)来支持心血管系统,直至患者康复。
一位 62 岁的男性,无相关病史,因咽痛和发热 1 天被转至我院。他被诊断为颈蜂窝织炎,后来发展为脓毒性休克,需要使用儿茶酚胺类药物和插管。随后发现患者患有多杀巴斯德氏菌菌血症,且家中养有宠物狗。除了脓毒症外,患者还出现难治性心源性休克,对药物治疗无反应;因此,启动了 VA-ECMO。引入 VA-ECMO 后,患者的血液动力学状态得到改善,在 6 天后脱离体外循环。他出院回家,50 天后恢复了以前的生活。
多杀巴斯德氏菌感染可导致健康成年人发生脓毒症,随后出现严重的心脏功能障碍。因此,VA-ECMO 可能是脓毒症引起的心肌功能障碍和难治性心源性休克患者的一种有用治疗选择。