背部皮肤软组织放线菌病一例并文献回顾

目的探讨皮肤软组织放线菌病的临床表现、诊断、鉴别诊断及治疗,提高创面外科医师对皮肤软组织放线菌病的认识。 方法报道1例背部皮肤软组织放线菌病的诊治经过,分别以"放线菌、放线菌感染、皮肤、软组织"及"actinomycosis,cutaneous,soft tissue"为检索词检索中国知网和PubMed的相关文献并进行分析。 结果与所检索20篇文献相比,本例皮肤放线菌病的临床表现、鉴别诊断及治疗既典型又具自身特点。本例患者入院时并未表现出明显皮肤肿物,但皮下感染组织内多个窦道,伴较多土褐色脓液流出较为典型。本例患者入院第9天才培养出放线菌,但无论是术中肉眼观察、细菌培养还是组织病理学检查均未见典型"硫磺颗粒"。本例患者查体、术中所见及辅助检查结果和气性坏疽的临床表现高度相似,因此最初曾高度怀疑产气荚膜梭菌感染,但多次细菌培养及涂片均未提示产气荚膜梭菌感染。治疗主要包括全身状态的调整、手术清创及抗生素的应用。 结论原发于皮肤软组织的放线菌病较少见,临床表现多样,即便有相对典型特征,也并无特异性,诊断需综合考虑并鉴别诊断。皮肤软组织放线菌感染发病率低,不易诊断,需引起创面外科医师的注意,及早对本病作出诊断及治疗。

Actinomycosis of the skin and soft tissue on the back: a case report and literature review

ObjectiveTo investigate the clinical manifestations, diagnosis, differential diagnosis and treatment of skin and soft tissue actinomycosis and to improve the wound surgeons’ understanding of skin and soft tissue actinomycosis. MethodsOne case of skin and soft tissue actinomycosis on the back was reported and related literatures with "actinomycosis, actinomycete infection, skin, soft tissue" and "actinomycosis, cutaneous, soft tissue" reviewed as searching terms in CNKI and PubMed, respectively. ResultsCompared with searched 20 literatures, it was typical with self-characteristic on the clinical manifestation, diagnosis, differential diagnosis and treatment. In this case, there was no obvious cutaneous mass on admission, but it was typical of multiple sinuses accompanied by more brown pus in the subcutaneous infected tissue. Actinomycetes were cultured from the patient on the 9th day after admission, however, no typical "sulfur particles" were observed by naked eye, bacterial culture and histopathology. The physical examination, intraoperative findings and auxiliary examination results of this case were highly similar to the clinical manifestations of gas gangrene, so that it was highly suspected of clostridium perfringens infection at first. But clostridium perfringens was not detected by repeated bacterial culture and smears. The treatment mainly included general treatment, surgical debridement and the use of antibiotics. ConclusionsPrimary skin and soft tissue actinomycosis is a rare disease with various clinical manifestations. There is relatively typical characteristics but no specificity. Therefore, the diagnosis should be considered comprehensively and differentiated carefully. Because of the low morbidity and difficulty in diagnosis, wound surgeons should pay attention to skin and soft tissue actinomycosis and make the correct diagnosis and treatment early.