Li Cheng, Yang Lili, Xu Min, Zhou Tao, He Junning, Yin Yijie, Liu Yongfang
Department of Infectious Diseases, the Third People's Hospital of Chengdu, Chengdu, Sichuan, 610031, China.
Department of Clinical Laboratory, the Third People's Hospital of Chengdu, Chengdu, Sichuan, 610031, China.
BMC Infect Dis. 2024 Dec 18;24(1):1416. doi: 10.1186/s12879-024-10329-9.
To enhance the current clinical understanding and improve the diagnosis and treatment of Actinotignum schaalii infections, we have presented here a report of the case of recurrent infections at a periumbilical scar, induced by Actinotignum schaalii and complicated by abscess formation in a 50-year-old woman with persistent festering at the site of a periumbilical scar after laparoscopy 9 years ago, with subsequent ruptures over the past 2 years. Physical examination revealed a radial fold scar with localized redness and slight swelling of the skin below the navel. Although no significant increase in the local skin temperature was noted, tenderness was present. A rupture at the site was also observed, and gentle compression produced a small amount of odorless and yellowish viscous pus. Anerobic culturing of the pus for 3 days revealed gray-white, non-hemolytic, spore-free, gram-positive, slightly curved rod-shaped bacteria. These bacteria were identified as A. schaalii using matrix-assisted laser desorption ionization time-of-flight mass spectrometry. The patient was subsequently treated with a 1-month course of oral amoxicillin, combined with debridement and drainage. Her condition improved with regular dressing changes. However, during follow-up 6-month later, the patient presented with a recurrence of the local infection at the scar site, again accompanied by abscess formation and rupture. Notably, the wound size was smaller, and after a 1-week treatment with silver ion, without any systemic antibiotic administration, her condition improved. Next, triamcinolone acetonide combined with lidocaine was injected into the scar three times. No further local infections were observed at the scar site during the subsequent 12-month follow-up.
为了增强当前对施氏放线杆菌感染的临床认识并改善其诊断和治疗，我们在此报告一例50岁女性的病例，该患者9年前腹腔镜检查后脐周瘢痕处反复感染，由施氏放线杆菌引起并伴有脓肿形成，在过去2年中出现破溃，脐周瘢痕部位持续化脓。体格检查发现一条放射状褶皱瘢痕，脐下皮肤局部发红且略有肿胀。虽然未发现局部皮肤温度明显升高，但有压痛。还观察到瘢痕处有一处破溃，轻轻挤压可挤出少量无异味的黄色黏稠脓液。脓液厌氧培养3天，发现灰白色、非溶血、无芽孢、革兰氏阳性、略弯曲的杆状细菌。使用基质辅助激光解吸电离飞行时间质谱法将这些细菌鉴定为施氏放线杆菌。该患者随后接受了为期1个月的口服阿莫西林治疗，并结合清创和引流。通过定期换药，她的病情有所改善。然而，6个月后的随访中，患者瘢痕部位再次出现局部感染，再次伴有脓肿形成和破溃。值得注意的是，伤口尺寸较小，在未使用任何全身性抗生素的情况下，用银离子治疗1周后，她的病情有所改善。接下来，在瘢痕处注射曲安奈德联合利多卡因3次。在随后12个月的随访中，瘢痕部位未再观察到局部感染。
