類鼻疽合併脾臟膿瘍一病例報告

Melioidosis Complicated with Splenic Abscess: A Case Report

10.6200/TCMJ.2013.10.4.09

李彩緣(Chai-Yuan Lee)；楊宗元(Tsung-Yuan Yang)

脾臟膿瘍 ； 類鼻疽 ； 類鼻疽伯克氏菌 ； splenic abscess ； melioidosis ； Burkholderia pseudomallei

北市醫學雜誌

10卷4期（2013 / 12 / 30）

369 - 373

繁體中文

目的：類鼻疽是類鼻疽伯克氏菌（Burkholderia pseudomallei）感染所引起，流行於東南亞及澳洲北部地區。感染之臨床症狀呈各內臟器官形成膿瘍，伴隨相當高的死亡率。本文報告一位因感染B. pseudomallei引起脾臟膿瘍及敗血症致死之病例。病例報告：一位49歲男性糖尿病患者，住院前一個月，有發燒、寒顫、咳嗽之臨床表徵。經治療後病情未改善，意識模糊、急性呼吸衰竭，轉送至本院加護病房接受進一步檢查及治療。於住院第7天時血液細菌培養出B. pseudomallei，給予調整抗生素治療（imipenem 500mg q6h）。患者仍不幸於住院第16天因敗血性休克而死亡。結論：在台灣罕見由於感染B. pseudomallei造成脾臟膿瘍，此病例提醒臨床醫療人員，對於糖尿病患者之脾臟膿瘍，應考量將B. pseudomallei列為可能的致病菌，同時參考可能流行地區之暴露史，對於「敗血症癥候，尤其是糖尿病之患者」應於第一時間使用高階第三代抗生素如ceftazidine、cabarpenem等，以針對類鼻疽或其他抗藥性致病菌種得以即早正確使用恰當之抗生素，降低死亡率。

Objective: Meliodiosis is caused by the Gramnegative bacterium Burkholderia pseudomallei (B. pseudomallei) and endemic in Northern Australia and Southeast Asia. Abscesses can occur at various organs and the clinical infectious symptoms are associated with a high mortality rate. In this article, we report a case of splenic abscess caused by B. pseudomallei in a septicemic patient. Report: The patient was a 49-year-old male with diabetic mellitus (DM), who presented to our hospital with productive high fever, chills and cough for one month. He then developed progressive disturbed consciousness and acute respiratory failure requiring intensive care unit admission. B. pseudomallei grew in blood culture on the 7th day after admission and meliodosis was diagnosed accordingly. Appropriate antibiotic treatment was adjusted in response to the results. Unfortunately, the patient died of septic shock on the 16th day of admission. Conclusion: Splenic abscesses caused by B. pseudomallei are rarely reported in Taiwan. We present an indigenous case of meliodosis in a DM patient, presenting septicemia caused by B. pseudomallei. We recommend a consideration of possible melioidosis when splenic abscesses are encountered in patients with DM combined sepsis for an appropriate antibiotics treatment.