姐弟先后患紫色色杆菌脓毒血症

发布时间：2018-09-19 12:33

【摘要】：报告2例姐弟先后患紫色色杆菌脓毒血症。例1.患儿女(姐姐),6岁。皮肤科检查:左乆窝下一4 cm×2 cm不规则溃疡面,表面可见黄色脓性分泌物和新生肉芽肿,周围肿胀。实验室及辅助检查:血常规中WBC 15.36×109/L,白细胞分类:N0.75,血涂片示中性粒细胞增多伴中毒性改变。分泌物及淋巴结穿刺液细菌培养示紫色色杆菌生长。彩超示多发性肝、脾脓肿。诊断:紫色色杆菌脓毒血症、多脏器脓肿。治疗:予静脉滴注头孢哌酮/舒巴坦(1.5 g,每日2次)抗感染,29 d后出现高热伴惊厥、腹痛及咳嗽,多脏器脓肿救治无效死亡。例2.患儿男(弟弟),5岁。皮肤科检查:双下肢散在分布数个大小不等暗红色肉芽肿样结节伴小脓疱,部分形成溃疡,周围有炎性浸润性红晕,双侧腹股沟触及增大的淋巴结伴压痛。实验室及辅助检查:血常规中WBC 29.39×109/L,N 0.86;降钙素原6.48μg/L,分泌物细菌培养示紫色色杆菌生长。诊断:紫色色杆菌脓毒血症。治疗:予静脉滴注亚胺培南(0.5 g,每日2次)和头孢哌酮/舒巴坦(1.5 g,每日2次),补液及对症支持,治疗20 d后患者双下肢溃疡结痂完全脱落,各项实验室检查均恢复正常。随访2年,病情无复发。
[Abstract]:Two cases of sepsis of chromobacterium purpura were reported. Example 1. The girl (sister) was 6 years old. Dermatology examination: left side of 4 cm 脳 2 cm irregular ulcer surface under the nest, yellow purulent secretion and new granuloma on the surface, swelling around. Laboratory and auxiliary examination: WBC 15.36 脳 10 9 / L in blood routine, WBC classification: n 0.75, blood smear showed neutropenia with toxic changes. Bacterial culture in secretion and lymph node puncture fluid showed the growth of chromobacterium purpura. Color Doppler ultrasound showed multiple liver and spleen abscess. Diagnosis: chromobacterium purpura sepsis, multiple organ abscess. Treatment: after intravenous cefoperazone / sulbactam (1.5 g, twice a day), fever with convulsion, abdominal pain and cough occurred 29 days later, and multiple organ abscess failed to cure death. Example 2. The boy (younger brother) was 5 years old. Dermatology examination: several dark red granulomatous nodules with small pustules were scattered in the lower extremities, with ulcers, inflammatory infiltrating red halo around, bilateral inguinal lymph nodes with tenderness. Laboratory and auxiliary examination: WBC 29.39 脳 10 9 / L N 0.86, procalcitonin 6.48 渭 g / L, secretion bacteria culture showed the growth of chromobacterium purple. Diagnosis: chromobacterium purpura sepsis. Treatment: intravenous drip of imipenem (0.5 g, twice a day) and cefoperazone / sulbactam (1.5 g, twice a day), fluid resuscitation and symptomatic support. After 20 days of treatment, the crusts of both lower extremity ulcers were completely scabbed off, and all laboratory examinations returned to normal. Follow-up for 2 years showed no recurrence.
【作者单位】：赣南医学院第一附属医院皮肤科;赣南医学院护理学院;
【分类号】：R720.597

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