Riecke K, Wagner S, Eller J, Lode H, Schaberg T
Institut für Mikrobiologie, Immunologie und Laboratoriums-medizin, Lungenklinik Heckeshorn, Berlin.
Pneumologie. 1997 May;51(5):499-502.
A patient who returned from a 3-year stay in Thailand and India one year ago, was admitted with fever of 38.5 degrees C and productive cough for the last four weeks. He remembered wounding his foot three years ago in India with contamination by soil. Subsequently, recurrent pustulae appeared on his feet. One such pustule was found on admittance. The clinical examination showed low body weight, without further abnormalities.
The blood examinations revealed high inflammation parameters and ruled out any immunodeficiency. Smouldering infiltrates in the upper lobes were found on the chest radiography. Sputum was free of acid fast bacilli and no mycobacterial DNA was detected by polymerase chain reaction. Bronchoscopy showed a normal endobronchal situation, Burkholderia pseudomallei were found to grow from specimens of bronchial mucus.
Under the empirical treatment with ampicillin/sulbactam, we could not find any response. After switching to Ceftazidime and trimethoprim/sulfamethoxazol (TMP/SMZ) we observed quick clinical improvement and normalisation of the inflammation parameters and notable radiological response over three weeks. We continued a five months TMP/SMZ therapy after discharge in order to prevent relapses.
For travellers and immigrants from Southeast Asia presenting smouldering infiltrations of the upper lobes, one should include Melioidosis in the differential diagnosis.
一名患者一年前结束了在泰国和印度的三年停留后回国，因过去四周持续发热38.5摄氏度和咳痰入院。他记得三年前在印度脚部受伤，伤口被土壤污染。随后，脚部反复出现脓疱。入院时发现一个这样的脓疱。临床检查显示体重偏低，无其他异常。
血液检查显示炎症指标升高，排除了任何免疫缺陷。胸部X线检查发现上叶有模糊的浸润影。痰液中未发现抗酸杆菌，聚合酶链反应未检测到分枝杆菌DNA。支气管镜检查显示支气管内情况正常，从支气管黏液标本中培养出了伯克霍尔德菌。
在使用氨苄西林/舒巴坦进行经验性治疗期间，未发现任何反应。改用头孢他啶和甲氧苄啶/磺胺甲恶唑（TMP/SMZ）后，我们观察到临床迅速改善，炎症指标恢复正常，三周内影像学有明显反应。出院后继续进行了五个月的TMP/SMZ治疗以预防复发。
对于出现上叶模糊浸润影的东南亚旅行者和移民，在鉴别诊断中应考虑类鼻疽。
