Jonsson S, Clarridge J, Young E J
Am Rev Respir Dis. 1983 Mar;127(3):357-9. doi: 10.1164/arrd.1983.127.3.357.
A patient with no known immune compromise presented with necrotizing pneumonia and a pleural effusion. Thoracentesis yielded a sanguinopurulent, foul smelling exudate that showed sheets of polymorphonuclear leukocytes and many gram-positive bacilli. A tube thoracostomy was performed and treatment with intravenous penicillin G was begun. Twenty-four hours later a Bacillus species later identified as Bacillus cereus was identified from aerobic cultures. Because the organism was resistant to penicillin, the patient was switched to intravenous chloramphenicol. A second organism was noted to grow slowly under anaerobic conditions and was later identified as Clostridium bifermentans. Despite initial clinical improvement, fever and empyema persisted resulting in a thoracotomy with resection of the infected lung and extensive decortication. Specimens from the lung tissue obtained at surgery also grew both Bacillus cereus and Clostridium bifermentans. Subsequent review of the original pleural fluid smears revealed a degree of pleomorphism that was not initially appreciated. Prompt surgical intervention combined with appropriate antibiotics resulted in a cure of this unusual aerobic/anaerobic infection.
一名无已知免疫功能受损的患者出现坏死性肺炎和胸腔积液。胸腔穿刺抽出了血性脓性、有恶臭的渗出液，其中可见成片的多形核白细胞和许多革兰氏阳性杆菌。进行了胸腔闭式引流，并开始静脉注射青霉素G治疗。24小时后，从需氧培养物中鉴定出一种芽孢杆菌属细菌，后来确定为蜡样芽孢杆菌。由于该菌对青霉素耐药，患者改用静脉注射氯霉素。还注意到另一种微生物在厌氧条件下生长缓慢，后来鉴定为双发酵梭菌。尽管最初临床症状有所改善，但发热和脓胸持续存在，导致进行了开胸手术，切除受感染的肺并进行广泛的胸膜剥脱术。手术中获取的肺组织标本也培养出了蜡样芽孢杆菌和双发酵梭菌。随后对原始胸腔积液涂片的复查显示出一定程度的多形性，这在最初并未被认识到。及时的手术干预与适当的抗生素联合使用治愈了这种不寻常的需氧/厌氧感染。
