Oršolić Martina, Sarač Nikolina, Balen Topić Mirjana
University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Mirogojska 8, 10 000 Zagreb, Croatia.
School of Medicine, University of Zagreb, Šalata 3, 10 000 Zagreb, Croatia.
Life (Basel). 2024 Sep 19;14(9):1183. doi: 10.3390/life14091183.
In addition to common skin pathogens, acute focal lymphadenitis in humans can, in rare cases, be caused by a zoonotic pathogen. Furthermore, it can develop in the absence of any direct or indirect contact with infected animals, in cases when the microorganism is transmitted by a vector. These clinical entities are rare, and therefore often not easily recognized, yet many zoonotic illnesses are currently considered emerging or re-emerging in many regions. Focal zoonotic vector-borne lymphadenitis and its numerous causative agents, with their variegated clinical manifestations, have been described in some case reports and small case series. Therefore, we summarized those data in this narrative overview, with the aim of raising clinical awareness, which could improve clinical outcomes. This overview briefly covers reported pathogens, their vectors and geographic distribution, and their main clinical manifestations, diagnostic possibilities, and recommended therapy. Vector-borne tularemia, plague, bartonellosis, rickettsioses, borreliosis, and Malayan filariasis are mentioned. According to the existing data, when acute focal bacterial vector-borne zoonotic lymphadenitis is suspected, in severe or complicated cases it seems prudent to apply combined aminoglycoside (or quinolone) plus doxycycline as an empirical therapy, pending definite diagnostic results. In this field, the "one health approach" and further epidemiological and clinical studies are needed.
除常见的皮肤病原体外，人类急性局灶性淋巴结炎在极少数情况下可由人畜共患病原体引起。此外，在微生物通过媒介传播的情况下，即使没有与受感染动物有任何直接或间接接触，也可能发生急性局灶性淋巴结炎。这些临床病症较为罕见，因此往往不易识别，但目前许多人畜共患病在许多地区被认为是新发或再发疾病。一些病例报告和小型病例系列中描述了局灶性人畜共患病媒介传播性淋巴结炎及其众多病原体，以及它们多样的临床表现。因此，我们在本叙述性综述中总结了这些数据，目的是提高临床认识，从而改善临床结果。本综述简要介绍了已报告的病原体、其传播媒介和地理分布，以及它们的主要临床表现、诊断方法和推荐治疗方法。文中提及了媒介传播的兔热病、鼠疫、巴尔通体病、立克次体病、疏螺旋体病和马来丝虫病。根据现有数据，当怀疑为急性局灶性细菌性媒介传播人畜共患病性淋巴结炎时，在严重或复杂病例中，在获得明确诊断结果之前，应用氨基糖苷类（或喹诺酮类）联合多西环素作为经验性治疗似乎是谨慎的做法。在这一领域，需要采取“同一健康”方法以及进一步开展流行病学和临床研究。
