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患者胆管癌伴肿瘤内脓肿合并血流感染:志贺邻单胞菌、弗氏柠檬酸杆菌、缓症链球菌/变异链球菌、产气荚膜梭菌和白假丝酵母菌感染的临床和微生物学特征:病例报告。

Clinical and microbiological features of intratumor abscess with bloodstream infection caused by Plesiomonas shigelloides, Citrobacter freundii, Streptococcus mitis/oralis, Clostridium perfringens, and Candida albicans in a patient with cholangiocarcinoma: A case report.

机构信息

Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.

Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.

出版信息

J Infect Chemother. 2022 Dec;28(12):1677-1681. doi: 10.1016/j.jiac.2022.08.024. Epub 2022 Sep 5.

Abstract

Plesiomonas shigelloides is a gram-negative facultative anaerobic bacillus, usually found in soil and freshwater, which causes self-limited diarrhea, although reports of bacteremia are rare. Here, we report the first case of an intratumoral abscess with mixed bacteremia caused by P. shigelloides, Citrobacter freundii, Streptococcus mitis/oralis, Clostridium perfringens, and Candida albicans in a patient with recurrent postoperative cholangiocarcinoma. A 77-year-old man with hilar cholangiocarcinoma and hypertension was admitted to our hospital with fever and abdominal pain. He had visited Vietnam for 3 years, 20 years ago. Abdominal computed tomography showed air within the recurrent tumor at the left liver lobectomy resection margin site, which was diagnosed as an intratumor abscess perforating the intestinal tract. P. shigelloides, C. freundii, S. mitis/oralis, C. perfringens, and C. albicans were isolated in blood culture. P. shigelloides was identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) and 16S ribosomal RNA (16S rRNA) sequencing. Piperacillin-tazobactam was administered for almost a week, ampicillin-sulbactam and levofloxacin for almost 3 weeks, and antifungal agents for almost 2 weeks, and the patient was discharged thereafter. Although bloodstream infections caused by P. shigelloides in patients with cancer are extremely rare, long-term colonization and the potential for future intra-abdominal infections were implicated.

摘要

嗜水气单胞菌是一种革兰氏阴性兼性厌氧菌,通常存在于土壤和淡水中,可引起自限性腹泻,尽管菌血症的报道很少。在这里,我们报告了首例由嗜水气单胞菌、弗氏柠檬酸杆菌、缓症链球菌/中间链球菌、产气荚膜梭菌和白色念珠菌引起的复发性胆管癌术后肝内肿瘤脓肿伴混合菌血症的病例。一名 77 岁男性,患有肝门部胆管癌和高血压,因发热和腹痛入住我院。他 20 年前曾在越南逗留 3 年。腹部 CT 显示左肝叶切除术后复发肿瘤边缘部位有肠道穿孔的肿瘤内脓肿,诊断为肠穿孔肿瘤内脓肿。血培养分离出嗜水气单胞菌、弗氏柠檬酸杆菌、缓症链球菌/中间链球菌、产气荚膜梭菌和白色念珠菌。通过基质辅助激光解吸电离飞行时间质谱(MALDI-TOF-MS)和 16S 核糖体 RNA(16S rRNA)测序鉴定出嗜水气单胞菌。患者接受了近一周的哌拉西林他唑巴坦、近 3 周的氨苄西林舒巴坦和左氧氟沙星以及近 2 周的抗真菌药物治疗,此后出院。尽管癌症患者由嗜水气单胞菌引起的血流感染极为罕见,但存在长期定植和未来腹腔内感染的潜在风险。

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