[1]王　曦,苍金荣a,归巧娣b,等.骨关节尖端赛多孢菌与偶发分枝杆菌感染实验室诊断和临床治疗[J].现代检验医学杂志,2021,36(06):124-127.[doi:10.3969/j.issn.1671-7414.2021.06.026]
　WANG Xi,CANG Jin-rong,GUI Qiao-di,et al.Laboratory Diagnosis and Treatment of Osteoarticular Infection Caused by Scedosporium Apiospermum and Mycobacterium Fortuitum[J].Journal of Modern Laboratory Medicine,2021,36(06):124-127.[doi:10.3969/j.issn.1671-7414.2021.06.026]
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骨关节尖端赛多孢菌与偶发分枝杆菌感染实验室诊断和临床治疗()
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《现代检验医学杂志》[ISSN:/CN:]

卷:
第36卷
期数:
2021年06期
页码:
124-127
栏目:
论　著
出版日期:
2021-12-15

文章信息/Info

Title:
Laboratory Diagnosis and Treatment of Osteoarticular Infection Caused by Scedosporium Apiospermum and Mycobacterium Fortuitum
文章编号:
1671-7414（2021）06-124-05
作者:
王　曦1; 苍金荣2a; 归巧娣2b; 周　楠2c; 刘宗智2d
（1.西安市红会医院关节病院，西安 710054；2.陕西省人民医院，a.检验科；b.陕西省临检中心；c.药学部；d骨科，西安710068）
Author(s):
WANG Xi;  CANG Jin-rong;  GUI Qiao-di;  et al
(1. Xi’an Honghui Hospital Joint Disease Hospital, Xi’an 710054，China；2a. Department of Clinical Laboratory；2b. Shaanxi Provincial Clinical Examination Center；2c. Department of Pharmaceutical ；2d .Department of Orthopedics, Shaanxi Provincial People’s Hospital, Xi’an 710068，China)
关键词:
骨关节感染; 偶发分枝杆菌; 尖端赛多孢菌
分类号:
R684.3；R446.5
DOI:
10.3969/j.issn.1671-7414.2021.06.026
文献标志码:
A
摘要:
目的　对1例骨关节尖端赛多孢菌与偶发分枝杆菌并发感染病例进行病原学诊断和治疗分析，为临床少见菌感染诊治提供思路。方法　将左大腿及左膝外伤后膝关节红肿骨科住院患者作为研究对象，采集其关节腔积液进行涂片染色、培养及质谱鉴定，根据病原学鉴定结果给予用药指导。结果　患者关节腔引流液外观为脓性乳糜状，涂片抗酸染色见大量白细胞和抗酸阳性呈柴捆状排列菌体；革兰染色见大量白细胞及真菌菌丝；荧光染色见团状菌丝。培养72h后血平板见丝状真菌菌落及细小、干燥的细菌样菌落，质谱仪鉴定为偶发分枝杆菌和尖端赛多孢菌混合感染。给予左氧氟沙星＋伏立康唑＋阿米卡星静脉滴注治疗14天，患者左膝关节肿胀明显减轻，左下肢肌力正常出院。出院医嘱改左氧氟沙星＋多西环素＋伏立康唑口服，因患者经济原因自行停服伏立康唑后复发再次入院，行关节积液培养再次分离出尖端赛多孢菌。临床清创并继续给予左氧氟沙星＋伏立康唑＋阿米卡星静脉滴注治疗，待症状改善后口服左氧氟沙星＋多西环素＋伏立康唑，期间肝功能检测有轻度损害，治疗方案改为口服左氧氟沙星＋复方磺胺甲噁唑＋伏立康唑直至出院，持续治疗6月后患者左膝关节肿胀消失，可自行站立行走，复查血细胞分析、C-反应蛋白、红细胞沉降率及肝肾功能均正常，逐渐停用所有药物。该患者停药后再无复发。结论　骨关节少见菌混合感染应重视实验室涂片检查和病原体鉴定，临床应该结合鉴定结果规范及足疗程治疗是患者治愈的关键。
Abstract:
Objective　To analyze the etiological diagnosis and treatment of rare cases of osteoarticular infection caused by Scedosporium apiospermum and Mycobacterium fortuitum, and provide ideas for the diagnosis and treatment of rare bacterial infection. Methods　A case of knee joint redness and swelling after left thigh and left knee trauma was taken as the research object. The joint cavity effusion was collected for smear staining, culture and mass spectrometry identification. Gave medication guidance according to the identification results. Results　The appearance of the drainage fluid in the joint cavity was purulent chylous. A large number of leukocytes and acid fast positive bacteria were seen in the Ziehl-Neelsen smear. Gram staining showed a large number of leukocytes and fungal hyphae and cluster hyphae could be seen by fluorescence staining. After 72 hours of culture, filamentous fungal colonies and small and dry bacterial colonies were found on the blood plate. The mass spectrometer identified the mixed infection of Scedosporium apiospermum and Mycobacterium fortuitum. The patient was given Levofloxacin + Voriconazole + Amikacin intravenous drip for 14 days. The swelling of the left knee joint was significantly reduced, and the muscle strength of the left lower limb was normal. Levofloxacin + Doxycycline + Voriconazole was taken orally. Due to the patient’s economic situation, he stopped taking voriconazole and was hospitalized again. Joint effusion culture report: Scedosporium apiospermum. After debridement, continue to give Levofloxacin + Voriconazole + Amikacin intravenous drip. After the symptoms improve, take Levofloxacin + Doxycycline + Voriconazole orally. During the period, check the liver function: ALT 166 U / L, AST 163 U / L, ALP 127 U / L and GGT 165 U / L. Take Levofloxacin + Sulfamethoxazole + Voriconazole orally until 6 months after discharge, the swelling of the patient’s left knee joint disappeared. He could stand and walk by himself. The blood routine, CRP, ESR and liver and kidney function were normal. All drugs were stopped one by one. The patient had no recurrence after drug withdrawal. Conclusion　The rare mixed osteoarticular infection should pay attention to laboratory smear examination and pathogen identification. Combined with the identification results, clinical standardized and adequate course of treatment are the key to the cure of patients.

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备注/Memo

备注/Memo:
作者简介：王曦(1987-)，男，硕士研究生，主治医师，研究方向：骨关节疾病，E-mail:wanghua2298@126.com。通讯作者：归巧娣（1978-），女，主任医师，E-mail:guiqiaodi1028@163.com。
更新日期/Last Update: 1900-01-01