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无中性粒细胞减少症的癌症患者中的巴斯德菌血症和渗出性中耳炎:通过病史采集和血培养进行早期诊断的经验教训

Pasteurella Bacteremia and Otitis Media With Effusion in a Cancer Patient Without Neutropenia: Lessons for Early Diagnosis Through History-Taking and Blood Cultures.

作者信息

Kitani Momoka, Iijima Kenta

机构信息

Department of Infectious Diseases, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, JPN.

出版信息

Cureus. 2025 Mar 30;17(3):e81460. doi: 10.7759/cureus.81460. eCollection 2025 Mar.

DOI:10.7759/cureus.81460
PMID:40303531
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12039944/
Abstract

often causes zoonotic infections, ranging from mild, localized cellulitis to severe sepsis, and can be life-threatening in immunocompromised patients. However, diagnosis can be challenging due to its varied and nonspecific symptoms. We report a case of bacteremia and otitis media with effusion in a 49-year-old female breast cancer patient undergoing chemotherapy without neutropenia. The patient presented with a sore throat, which was followed by headache, ear fullness, and fever. She was initially diagnosed with a viral infection and sent home. Two days later, blood cultures revealed Gram-negative coccobacilli, which were later identified as . The patient reported close contact with dogs but no bites or scratches. Further examination revealed otitis media with effusion. Treatment with ceftriaxone was initiated and subsequently switched from ceftriaxone to ampicillin, then to oral amoxicillin. The patient's symptoms improved, and she was discharged without sequelae after 10 days of antibiotic therapy. Through a literature review, we identified a high rate of central nervous system complications associated with acute otitis media, underscoring the necessity for early diagnosis. This case highlights the importance of thorough history-taking, including inquiry about animal exposure, and prompt blood culture acquisition in febrile cancer patients without neutropenia to ensure timely and effective management of potentially life-threatening infections.

摘要

常引起人畜共患感染,范围从轻度的局部蜂窝织炎到严重的败血症,在免疫功能低下的患者中可能危及生命。然而,由于其症状多样且不具特异性,诊断可能具有挑战性。我们报告一例49岁接受化疗但无中性粒细胞减少的女性乳腺癌患者发生菌血症和渗出性中耳炎的病例。患者最初出现喉咙痛,随后出现头痛、耳部胀满和发热。她最初被诊断为病毒感染并被送回家。两天后,血培养显示革兰氏阴性球杆菌,后来被鉴定为……患者报告与狗有密切接触,但无咬伤或抓伤。进一步检查发现渗出性中耳炎。开始用头孢曲松治疗,随后从头孢曲松改为氨苄西林,然后改为口服阿莫西林。患者症状改善,抗生素治疗10天后出院,无后遗症。通过文献综述,我们发现急性中耳炎相关的中枢神经系统并发症发生率很高,强调了早期诊断的必要性。该病例突出了全面问诊的重要性,包括询问动物接触史,以及在无中性粒细胞减少的发热癌症患者中及时进行血培养,以确保对潜在危及生命的感染进行及时有效的管理。

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本文引用的文献

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比较不同的脓毒症评分系统和途径:qSOFA、SIRS、Shapiro 标准和 CEC SEPSIS KILLS 途径在就诊于急诊科的菌血症和非菌血症患者中的应用。
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Bacteremic meningitis due to resistant to first line antibiotic therapy.对一线抗生素治疗耐药所致的菌血症性脑膜炎。
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