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中华卫生应急电子杂志 ›› 2022, Vol. 08 ›› Issue (05) : 316 -319. doi: 10.3877/cma.j.issn.2095-9133.2022.05.012

个案报告

高毒力肺炎克雷伯菌感染致MODS一例并文献复习
王元元1, 王婷2, 许铎1, 沈继龙1, 邓岩军1, 周情太1, 汪明灯1,()   
  1. 1. 215153 江苏苏州,苏州科技城医院重症医学科
    2. 215153 江苏苏州,苏州科技城医院检验科
  • 收稿日期:2022-06-07 出版日期:2022-10-18
  • 通信作者: 汪明灯
  • 基金资助:
    资助基金项目:苏州市医学重点学科(SZXK202131); 苏州市科技发展计划((医疗卫生科技创新)项目(SKJY2021034); 苏州高新区医疗卫生科技计划重点项目(2019Z004)

Highly virulent Klebsiella pneumoniae infection to MODS: report of a case and review of literature

Yuanyuan Wang1, Ting Wang2, Duo Xu1   

  • Received:2022-06-07 Published:2022-10-18
引用本文:

王元元, 王婷, 许铎, 沈继龙, 邓岩军, 周情太, 汪明灯. 高毒力肺炎克雷伯菌感染致MODS一例并文献复习[J/OL]. 中华卫生应急电子杂志, 2022, 08(05): 316-319.

Yuanyuan Wang, Ting Wang, Duo Xu. Highly virulent Klebsiella pneumoniae infection to MODS: report of a case and review of literature[J/OL]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2022, 08(05): 316-319.

高毒力肺炎克雷伯菌(hypervirulent Klebsiella pneumoniae,HvKP)的侵袭力强、毒力强,可导致坏死性筋膜炎、骨髓炎、化脓性肝脓肿、眼内炎等严重侵袭性疾病,致残率及致死率高,预后差,近年来一直成为研究的热点。笔者报告一例以发热伴血糖升高为首发症状,并迅速进展为多器官功能障碍综合征的HvKP感染患者。现将诊疗过程与体会报告如下。

图1 肝脓肿超声图像注:肝右后叶见范围约80 mm×62 mm的混合回声区,边界欠清,形态欠规则,其内见片状无回声,内透声差,其一范围约50 mm×45 mm,CDFI未见明显异常血流信号
图2 高毒力肺炎克雷伯菌致肝脓肿增强CT图像注:a为冠状位影像可见肝右叶不规则低密度影,最大层面7.7 cm×5.4 cm,密度欠均匀;b为横断位影像可见肝脓肿增强扫描边缘轻度环形强化,病灶周围肝组织内可见一圈水肿带样低密度环绕,其内可见分割线
图3 超声引导下肝脓肿穿刺引流,回抽出浑浊深黄色脓性液体
图4 肝脓肿引流液为浑浊深黄色脓性液体,置于培养瓶中
图5 感染指标及血小板变化趋势注:PCT降钙素原,CRP为C-反应蛋白,WBC为白细胞;患者感染指标PCT、CRP、WBC在术前异常增高,12月27日超声引导下肝脓肿穿刺引流后,感染指标明显下降,血小板迅速回升。(横坐标为日期,纵坐标为相应数值)
图6 黏液型肺炎克雷伯菌拉丝试验阳性注:当黏液表型的菌落接触到线圈时,该线圈从琼脂板表面提起黏液丝>5 mm
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