Henwick S, Koehler M, Patrick C C
Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee 38101-0318.
Clin Infect Dis. 1993 Oct;17(4):667-71. doi: 10.1093/clinids/17.4.667.
Stomatococcus mucilaginosus, a normal inhabitant of the human oral cavity and upper respiratory tract, can cause fatal sepsis and meningitis in neutropenic patients. We identified eight cases of bacteremia due to S. mucilaginosus in children with cancer, of whom five developed complications despite receiving appropriate antibiotics. At the time cultures were positive, seven patients had profound neutropenia (< 100 neutrophils and band forms/mm3) and four had mucositis; five had central venous catheters. In two cases, there was unequivocal evidence of catheter-related sepsis. Bacteremia was eradicated in all patients within 48 hours after initiation of antibiotics. Despite prompt instigation of effective antibiotic therapy, the complication rates in this series were high: septic shock (50%), pneumonia (50%), dermatologic manifestations (38%), altered neurological status (25%), meningitis (13%), and adult respiratory distress syndrome (13%). No fatalities were attributable to S. mucilaginosus infection. These cases illustrate the virulence of S. mucilaginosus organisms in neutropenic children and suggest a substantial risk of sequelae even when adequate antibiotic therapy is given.
黏性口腔球菌是人类口腔和上呼吸道的正常寄居菌，可在中性粒细胞减少的患者中引起致命的败血症和脑膜炎。我们鉴定出8例癌症患儿发生了由黏性口腔球菌引起的菌血症，其中5例尽管接受了适当的抗生素治疗仍出现了并发症。在培养结果呈阳性时，7例患者有严重的中性粒细胞减少（<100个中性粒细胞和杆状核细胞/mm³），4例有黏膜炎；5例有中心静脉导管。在2例中，有明确的导管相关败血症证据。所有患者在开始使用抗生素后48小时内菌血症均被根除。尽管迅速启动了有效的抗生素治疗，但该系列中的并发症发生率仍很高：感染性休克（50%）、肺炎（50%）、皮肤表现（38%）、神经状态改变（25%）、脑膜炎（13%）和成人呼吸窘迫综合征（13%）。没有死亡病例归因于黏性口腔球菌感染。这些病例说明了黏性口腔球菌在中性粒细胞减少儿童中的毒力，并表明即使给予了充分的抗生素治疗，仍有很大的后遗症风险。
