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血液和胸水中同时检出河流弧菌1例

2018-02-01 佚名 临床医药文献杂志

河流弧菌
关注

患者，男，46岁，工人

【一般资料】

患者，男，46岁，工人

【主诉】

因“腹胀、尿少半月余，加重1周”于2016年05月31日住院治疗。

【现病史】

患者原有“乙肝肝硬化失代偿期”4年余，入院前半月无明显诱因出现上腹不适，上腹部饱胀，进食后加重，进食量逐渐下降，约为原来的1/3，尿量减少。病后一周曾就诊于我院门诊，建议住院治疗，患者拒绝，在家服用“呋塞米、螺内酯”等药物，无好转，再次就诊于我院门诊，拟“乙肝肝硬化失代偿期”收住感染科，患者病后精神欠佳，睡眠一般，大便正常。

【体格检查】

T36.5℃，P80次/分，R18次/分，BP130/80mmHg。神志清楚，精神欠佳，慢性肝病面容，面色晦暗，全身皮肤、巩膜无黄染，右肺呼吸音低，左肺呼吸音粗，双肺未闻及干湿性罗音，心率80次/分，律齐，心音未见异常。腹膨隆，可见腹壁静脉显露，全腹无压痛及反跳痛，肝、脾肋下未触及，肝、肾区无叩击痛，移动性浊音阳性，双下肢无水肿。

【辅助检查】

TBIL19.2u/L，DBil8.7u/L，ALT32.2u/L，AST44.4u/L、Alb31.8g/L；肾功能、电解质、血脂分析均正常；HBV-DNA：＜1.00E+03IU/mL。胸、腹部B超提示：肝硬化、脾肿大、腹腔积液、胸腔积液。2016年6月4日患者出现畏寒、发热，解黄色稀水样大便4次，发热时抽血和胸水培养，临床考虑有感染，予以头孢唑肟治疗，应用复合乳酸菌调节肠道菌群。两天后体温恢复正常。6月5日、6月6日复查血、胸水、腹水培养均阴性。细菌分离培养、鉴定及药敏试验患者2016年6月4日分两次不同部位抽取静脉血液，同时抽取胸水，于梅里埃FA中和抗生素需氧培养瓶增菌后，置梅里埃BacT/ALERT3D全自动血培养仪监测，均报警阳性。涂片并转种于血琼脂平板和麦康凯平板。直接涂片可见运动活泼呈穿梭状，革兰染色可见微弯曲革兰阴性杆菌。经35℃培养18-24小时后，血平板上形成灰白色、圆形、湿润、稍凸起、不透明、有β溶血环、中等大小的菌落；麦康凯平板上形成光滑、湿润、中等大小的菌落。1.生化反应（1）杭州滨和微生物试剂有限公司生产的鉴定弧菌用含盐生化管：氧化酶（+）、精氨酸（+）、鸟氨酸（-）、赖氨酸（-）、甘露醇（+）、水杨苷（-）、V-P（-）、蔗糖（+）、阿拉伯糖（-）、枸橼酸盐（-）。（2）西门子公司的MicroScanWalkAway40全自动细菌鉴定仪鉴定为河弧菌，生物表型：61000011，鉴定值：95.85%。2.药敏结果阿莫西林/克拉维酸、哌拉西林/他唑巴坦、氨苄西林、亚胺培南耐药，哌拉西林中介，阿米卡星、头孢他啶、头孢噻肟、头孢西丁、头孢唑林、环丙沙星、头孢吡肟、头孢呋肟、庆大霉素、左氧氟沙星、美罗培南、复方新诺明、四环素敏感。

【讨论】

弧菌属菌种栖居于海洋水产品及小海鲜类动物肠道和体表，除弗氏弧菌外，全部是人类致病菌，皆可在人类临床标本中分离到。河流弧菌属弧菌属，引起散发性腹泻，很少引起肠道外感染。河流弧菌是经口传播的病原菌，人体通过摄入污染的水、食物而感染，主要引起人类急性胃肠道炎症，典型症状是水样便、腹痛、轻到中度脱水、常伴有发热，而引起肠道外感染非常少见。本病例原有乙肝肝硬化失代偿4年，免疫力低下，易导致感染。2016年06月04日患者出现畏寒、发热，解黄色稀水样大便，疑为河流弧菌感染，但未留取粪便培养。血液、胸水培养结果为河流弧菌，可能是通过肠道进入循环导致感染。三代头孢抗感染治疗后，培养阴性，体温正常，治疗有效。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=285780, encodeId=39a7285e8043, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 06 23:55:07 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285560, encodeId=8a7f285560f3, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Feb 06 07:06:52 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284414, encodeId=1918284414f0, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Feb 02 08:17:04 CST 2018, time=2018-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284279, encodeId=08e82842e92d, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:40 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284278, encodeId=c23b2842e886, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:34 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284216, encodeId=d9f0284216ac, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Feb 01 19:02:26 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-06 天涯183

    非常好的文章.学习了

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=285780, encodeId=39a7285e8043, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 06 23:55:07 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285560, encodeId=8a7f285560f3, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Feb 06 07:06:52 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284414, encodeId=1918284414f0, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Feb 02 08:17:04 CST 2018, time=2018-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284279, encodeId=08e82842e92d, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:40 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284278, encodeId=c23b2842e886, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:34 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284216, encodeId=d9f0284216ac, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Feb 01 19:02:26 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-06 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=285780, encodeId=39a7285e8043, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 06 23:55:07 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285560, encodeId=8a7f285560f3, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Feb 06 07:06:52 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284414, encodeId=1918284414f0, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Feb 02 08:17:04 CST 2018, time=2018-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284279, encodeId=08e82842e92d, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:40 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284278, encodeId=c23b2842e886, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:34 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284216, encodeId=d9f0284216ac, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Feb 01 19:02:26 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-02 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=285780, encodeId=39a7285e8043, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 06 23:55:07 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285560, encodeId=8a7f285560f3, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Feb 06 07:06:52 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284414, encodeId=1918284414f0, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Feb 02 08:17:04 CST 2018, time=2018-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284279, encodeId=08e82842e92d, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:40 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284278, encodeId=c23b2842e886, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:34 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284216, encodeId=d9f0284216ac, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Feb 01 19:02:26 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-01 风飞

    学习一下.增加新知识储备!

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=285780, encodeId=39a7285e8043, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Tue Feb 06 23:55:07 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=285560, encodeId=8a7f285560f3, content=学习了.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Tue Feb 06 07:06:52 CST 2018, time=2018-02-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284414, encodeId=1918284414f0, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Fri Feb 02 08:17:04 CST 2018, time=2018-02-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284279, encodeId=08e82842e92d, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:40 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284278, encodeId=c23b2842e886, content=学习一下.增加新知识储备!, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/02/01/b119cf52e9aa56332062f9070d8f4c26.jpg, createdBy=bc4d2263557, createdName=风飞, createdTime=Thu Feb 01 23:29:34 CST 2018, time=2018-02-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=284216, encodeId=d9f0284216ac, content=学习了受益匪浅, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDicHg2ldsSNmib46PmdzpO7CQEmPjuULp1v45zPWwMYhrnXgvl3OtmUCZSQfgITWn96X9moL94nUGA/0, createdBy=28072041016, createdName=131****1460, createdTime=Thu Feb 01 19:02:26 CST 2018, time=2018-02-01, status=1, ipAttribution=)]
    2018-02-01 风飞

    学习一下.增加新知识储备!

    0

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    2018-02-01 131****1460

    学习了受益匪浅

    0