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NEJM：皮肤白喉-病例报道

2018-03-29 xing.T MedSci原创

皮肤白喉瘙痒皮损
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皮肤白喉早期表现可出现边界清楚的溃疡愈合。该病人进行白喉检测后，服用的抗生素改为克拉霉素。追踪接触者，并给家庭接触者进行药物预防。

患者为一名5岁完全接种疫苗的女孩，因双腿瘙痒性皮损而到急诊就诊。
 
她最近刚从塞拉利昂旅行回来。她到那里3周后出现上述病灶，并且病灶有所增大，并且出现溃疡。在就诊过程中，她不发热，左小腿内侧区出现了溃疡和出血（如图A所示）。C反应蛋白水平轻度升高，白细胞计数正常。开始口服氟氯西林进行经验性治疗，并且进行皮肤拭子培养，其中金黄色葡萄球菌、A组链球菌和白喉棒状杆菌阳性。
 



Gram染色显示革兰阳性杆菌主要以棒状杆菌为主（如图B所示）。免疫扩散试验（Elek’s试验）阳性，表明这是白喉毒素产生所致。皮肤白喉早期表现可出现边界清楚的溃疡愈合。该病人进行白喉检测后，服用的抗生素改为克拉霉素。追踪接触者，并给家庭接触者进行药物预防。
 
该患者在采用克拉霉素进行抗生素治疗1周后，皮损完全愈合。
 
原始出处：
 
Isabel E. Wilson,et al. Cutaneous Diphtheria.N Engl J Med 2018. http://www.nejm.org/doi/full/10.1056/NEJMicm1701825
 
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    2018-03-31 小贝熊

    学习学习学习

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=301316, encodeId=4c1b3013164b, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/27/6f2d63c799d68129300901eb0e962dd4.jpg, createdBy=ddf12178538, createdName=小贝熊, createdTime=Sat Mar 31 00:34:18 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515758, encodeId=92651515e58b0, content=<a href='/topic/show?id=1efde166406' target=_blank style='color:#2F92EE;'>#白喉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71664, encryptionId=1efde166406, topicName=白喉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3eb510868243, createdName=ms8538335253054589, createdTime=Fri Mar 30 23:12:00 CST 2018, time=2018-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300988, encodeId=49e230098827, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/27/6f2d63c799d68129300901eb0e962dd4.jpg, createdBy=ddf12178538, createdName=小贝熊, createdTime=Fri Mar 30 00:34:38 CST 2018, time=2018-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300820, encodeId=5e45300820ef, content=好知识.值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Mar 29 08:30:23 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300812, encodeId=738330081295, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=5, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Thu Mar 29 08:16:08 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-30 ms8538335253054589

    #白喉#

    0

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    2018-03-30 小贝熊

    学习学习学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=301316, encodeId=4c1b3013164b, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/27/6f2d63c799d68129300901eb0e962dd4.jpg, createdBy=ddf12178538, createdName=小贝熊, createdTime=Sat Mar 31 00:34:18 CST 2018, time=2018-03-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1515758, encodeId=92651515e58b0, content=<a href='/topic/show?id=1efde166406' target=_blank style='color:#2F92EE;'>#白喉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71664, encryptionId=1efde166406, topicName=白喉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3eb510868243, createdName=ms8538335253054589, createdTime=Fri Mar 30 23:12:00 CST 2018, time=2018-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300988, encodeId=49e230098827, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/03/27/6f2d63c799d68129300901eb0e962dd4.jpg, createdBy=ddf12178538, createdName=小贝熊, createdTime=Fri Mar 30 00:34:38 CST 2018, time=2018-03-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300820, encodeId=5e45300820ef, content=好知识.值得学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Thu Mar 29 08:30:23 CST 2018, time=2018-03-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=300812, encodeId=738330081295, content=了解了解.学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=5, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=93f31631454, createdName=1dd8c52fm63(暂无匿称), createdTime=Thu Mar 29 08:16:08 CST 2018, time=2018-03-29, status=1, ipAttribution=)]
    2018-03-29 zb1235672

    好知识.值得学习

    0

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    2018-03-29 1dd8c52fm63(暂无匿称)

    了解了解.学习学习

    0