伤寒杆菌致感染性腹主动脉瘤合并腹腔脓肿1例

[摘要]　伤寒杆菌感染所致的感染性动脉瘤是一种罕见且病死率较高的疾病,是沙门菌感染肠外并发症中最严重的疾病,常发生在高龄或者免疫力低下患者,患者多表现为发热或者相应位置的疼痛,但初期表现一般不典型,临床容易漏诊、误诊。伤寒杆菌所致的感染性动脉瘤治疗须手术及抗感染治疗同步进行,如抗感染治疗不充分则容易造成术后感染复发,导致病情加重、局部形成化脓性病灶。本文汇报1例表现为发热、腹痛的伤寒杆菌所致的感染性腹主动脉瘤,予以抗感染及腹主动脉瘤覆膜支架腔内修复术,但患者术后仍有反复发热。血培养结果为伤寒杆菌,根据药物敏感性试验结果调整抗感染治疗方案,但疗效欠佳,予以全麻下行剖腹探查,手术中发现腹腔脓肿,予以切开引流。术后患者一般情况可,未再腹痛和发热。     

氟哌酸治疗慢性伤寒带菌者的应用

作者按双盲、随机、对照设计,用氟哌酸(nor-floxacin)与安慰剂对25例无症状的慢性伤寒杆菌携带者作了疗效、安全性和耐受性比较。临床资料参与者均为大便或胆汁伤寒杆菌培养阳性持续达12个月以上。有过敏体质、患严重系统性疾病、合并感染、肾功能中至重度不全和孕妇均除外。治疗前均作口服胆囊造影、静脉胆囊造影或胆囊     

EIA作沙门氏菌感染的血清学诊断

作者利用伤寒及肠炎沙门菌菌体脂多糖(LPS)作为抗原,建立了能检测沙门菌属感染所产生的血清特异性 IgM、IgG 及 IgA 的酶免疫测定(EIA)方法。实验检测的130例均为大便培养阳性病例。年龄1～76岁,儿童13例,成人117例。其中为鼠伤寒杆菌88例,肠炎沙门菌20例,其它沙门菌22例。除63例鼠伤寒杆菌感染病人标本,在起病后2.5个月采取外,其余标本均在感染后1～3周采集。对照组分两组:一组为来自同一地区100名健康献血员,另一组为非沙门菌引起的其它急性感染病例。     

伤寒带菌者问题

伤寒仍是一个重要的公共卫生问题,在许多发展中地区流行。慢性带菌者是最重要的传染宿主,是决定地方伤寒流行水平的主要因素,亦是散在暴发的重要来源。慢性带菌者不断地把伤寒杆菌通过胆汁排入肠道。然而,粪便培养可仅呈间歇阳性,因为伤寒杆菌的生存及其在粪便培养中生长取决于粪便的类型和正常粪便菌丛的抑制作用。带菌状态可发生在临床或亚临床感染之后,存在胆囊疾病的患者往往容易变为带菌者。因此,变为带菌者的机会随着感染发生的年龄而增高,女性比男性多见。迄今尚无适用于在大量人群中检测带菌者的简易     

伤寒并发肝功能损害 42 例临床分析

伤寒是由伤寒杆菌引起的急性肠道传染病。肝脏是伤寒杆菌侵犯的主要靶器官之一，并引起肝功能异常。现将我院2000年1月至2005年12月收治的80例伤寒患者的肝损害情况作一回顾性分析。     

特发性乙状结肠穿孔24例老年患者临床分析

目的 探讨老年人特发性乙状结肠穿孔的临床特征。方法 回顾性分析老年特发性乙状结肠穿孔患者24例的发病诱因、临床特征和治疗效果。结果 24例平均年龄68．7岁，均突然发病，平均病程5．2h。19例有习惯性便秘。表现为全腹膜炎21例(87．5％)，局限性腹膜炎3例，术前仅确诊4例，误诊20例(83．3％)，其中误诊为急性阑尾炎穿孔9例，上消化道穿孔7例，绞窄性肠梗阻4例。24例均行手术治疗，20例痊愈出院；死亡4例(16．7％)，3例死于感染中毒性休克，1例死于并发肺部感染。结论 认真询问病史，加强认识，对本病诊断极为重要；早期手术是治疗本病的根本措施，正确处理穿孔、彻底清洗腹腔、清洁肠道及术后充分引流是治疗本病的关键。     

从伤寒患者的不同检材分离培养伤寒杆菌的比较

本文报告62例伤寒病人血液、尿液、直肠拭子、骨髓及玫瑰疹培养伤寒杆菌的结果。这些病人大多数曾用过抗菌素治疗,但具体情况不详。其中12例于病程1周后作培养;26例于2周后;24例于3～4周后培养。 62例中,56例(90％)骨髓培养伤寒杆菌阳性。     

伤寒与肥达反应

本文70例经血或骨髓培养伤寒杆菌阳性患者,肥达反应阳性54例,占77.2%,其余肥达反应始终为阴性。故肥达反应阴性除非血或骨髓伤寒杆菌培养阴性,不可否定诊断。早期应用抗伤寒药物,明显影响肥达反应效价。     

肠伤寒穿孔30例诊治体会

1978年～ 1998年 ,临沂市人民医院与新疆喀什卫生学校附属医院手术治疗肠伤寒穿孔 30例。现分析报告如下。临床资料 :本组男 2 1例 ,女 9例 ;年龄 10～ 6 0岁 ,平均年龄 2 1岁。 19例有伤寒典型的表现 ,如高热寒战 ,相对缓脉 ,玫瑰疹 ,肝脾肿大及神经系统中毒症状等 ,发病后 2～ 3周相继出现持续性右下腹痛、腹膜炎体征 ;11例仅有轻微症状如头痛不适 ,四肢酸痛 ,恶心、腹泻、食欲不振等。实验室检查 :WBC>10× 10 9/L者 18例 ,余 12例无升高。16例作肥达氏试验 ,10例阳性 ;血培养 5例 ,发现伤寒杆菌者 1例 ;大便培养10例 ,阳性者 1例 ;腹…     

急性血吸虫病与伤寒双重感染4例报告

急性血吸虫病与伤寒双重感染在临床上不难遇见，１９９５年我院收治５７例急性血吸虫病就有４例是双重感染者（经ＩＨＡ，循环抗原及肥达氏反应、血培养伤寒杆菌确诊），约占７％。此类病人往往病情较重，处理不当将引起严重后果，故将临床特征及治疗情况报告如下。１　一般资料　本组４例，男２例，年龄２岁、１１岁儿童；女２例，年龄２８岁、２９岁农民。２　临床表现　４例均来自血吸虫病流行区，接触疫水后２８～８０天发病。体温：３例３９～３９５℃，１例高达４０℃，热峰出现于午后，热型呈弛张型。４例均存在低血压状态，均无相…     

Clinical evaluation of anaerobic infections in patients with bronchopulmonary infections diagnosed by transtracheal aspiration]

We evaluated the clinical and bacteriologic features in the patients with bronchopulmonary infections isolated anaerobes from transtracheal aspirates between April 1990 and March 1998. Some anaerobe was isolated in 42 (10.9%) in 387 patients whom we performed transtracheal aspiration (TTA), in 42 (15.7%) of 268 in whom some organism was isolated from TTA, or in 42 (16.3%) of 257 patients in whom some bacterium excluding acid-fast bacteria, fungi or mycoplasma from TTA. The isolation rate of anaerobic bacteria was 93.3% in the patients with lung abscess, 22.7% in the patients with nosocomial pneumonia, 19.4% in the patients with community-acquired pneumonia, 26.7% in the patients with acute exacerbation of chronic lower respiratory tract infection (CLRTI), 1.6% in the patients with persistent infection of CLRTI, and 3.0% in the patients with acute bronchitis, respectively. The major anaerobes, isolated from TTA, were Peptostreptococcus micros and Prevotella melaninogenica. The aerobic bacteria were isolated with anaerobic bacteria in 32 of 42 patients at the same time. The quantitive grade of colonial growth of anaerobes was equal to or more than aerobes in the patients with lung abscess and pneumonia. We mostly administrated 3rd generation cephems or carbapenems with or without clindamycin for the treatment of anaerobic infections. Forty-one of 42 patients were cured only by the therapy of antimicrobial agents, but pneumonia patient with lung cancer died in spite of adequate antimicrobial therapy. These results suggest that the anaerobic infections are important in the bronchopulmonary infections.     

Analysis of 98 cases of thoracic empyema]

Ninety-eight cases of empyema thoracis admitted to Juntendo University Hospital between 1979 and 1990 were reviewed. Males accounted for 78 cases and females 20 cases. Thirteen pediatric patients ranged in age from 17 days to 4 years, while the 85 adult cases ranged from 16 to 89 years (mean: 58.4 years). The mortality rate increased with age. Fifty-three cases of community-acquired empyema thoracis consisted of 24 with no underlying disease (including 13 pediatric cases), and 29 with diabetes mellitus, alcoholic liver damage or chronic obstructive bronchopulmonary disease. Forty-five nosocomial empyema cases occurred after chest operation or thoracocentesis, or due to a subdiaphragmatic pathogenic condition or congestive heart failure complicated with aspiration pneumonia. In this series, 63 patients (64.3%) had para- or post-pneumonic empyema. Compared with the community-acquired infection cases, the mortality rate of the nosocomial infection cases was very high. Seventy-eight cases were culture-positive, including 3 positive for Mycobacterium tuberculosis. The remaining 20 cases were culture-negative. In 75 cases of culture-positive pleural fluid, aerobic bacteria were isolated from 31 cases (mortality rate: 22.6%), anaerobes mixed with aerobes from 21 cases (mortality rate: 52.4%), and anaerobes only from 23 cases (mortality rate: 21.7%). Thus, the mortality rate of mixed infected cases was highest. Anaerobes were frequently isolated from the community-acquired empyema cases, and were often found in para- or postpneumonic lesions, including aspiration pneumonia. The most commonly encountered aerobe was Staphylococcus aureus. Among the anaerobes, Bacteroides spp., microaerophilic streptococcus, Peptostreptococcus and Fusobacterium spp. were most common. A single organism was isolated in pure culture from 39 cases. Single organisms isolated from fluids were more frequently aerobes (25) than anaerobes (14). The cases harboring Bacteroides spp. showed the worst outcome, with 11 deaths in 25 such cases.     

Nitrate-Reducing Bacteria in Diversion Colitis (A Clue to Inflammation?)

A pathogenic role of nitric oxide has beensuggested in acute and chronic intestinal inflammation.We took the opportunity offered by studies in patientswith excluded colon, which represents a model of chronic intestinal inflammation with noexogenous nitrite or nitrate supply, to evaluate thequantity and the quality of nitrate reducers indiversion colitis. Thirty patients (17 men, 13 women,mean age 45 years) having an excluded colonfor variousreasons were sampled by rectal swabs and compared to 30healthy controls (11 men, 19 women, mean age 28 years).The percentage of nitrate-reducers among the total count of subcultured bacteria was 46± 41% (mean ± SD) in patients withdiversion colitis as compared to 19 ± 24% inhealthy controls. This difference was significant (P< 0.05) despite great heterogeneity in individual values. In patientswith diversion colitis, 75/254 (29.5%) differentisolated bacterial strains were nitrate-reducers ascompared to 61/294 (21%) (P < 0.05) in controls.Among the 75 nitrate-reducing strains isolated frompatients with diversion colitis, 55 were aerobes.Pseudomonas species were only encountered in thispopulation. The predominant group was enterobacteriawith a high isolation rate of species belonging tothe genera Proteus, Providencia, and Morganella . Inhealthy controls nitrate-reducing anaerobes were nearlyas frequent as aerobes. The most frequent species was Eubacterium lentum, followed by Clostridiumperfringens. It could be suggested that nitric oxidesynthase might produce a bacterial substrate increasingthe growth of bacteria with a high pathogenic potential, creating conditions for chronicinflammation and infection in patients with excludedcolon.     

腹腔镜胆囊切除术患者抗生素应用的研究

目的 探讨腹腔镜胆囊切除术（ＬＣ）患者抗生素应用的意义。结果 ＬＣ时抽取１５０例胆汁做培养和药敏试验,并将３８０例ＬＣ者分５组;第一组急性炎症组３２例,第二组镜下炎症组５１例,第三组术中胆囊剥破组２８例,第四组单纯结石或息肉组７２例;分别配合不同的抗生素治疗方法。结果 胆汁需氧菌检出率７７．３％厌氧菌检出率６２．７％。药敏试验：第三代头孢菌素及甲硝唑、夫硝唑有效率高。第一组、第二组术后血白细胞计数     

糖尿病足合并感染患者532株病原菌分布及耐药性分析

目的 探讨我国西南地区糖尿病足溃疡处常见病原菌分布及耐药情况.方法 回顾分析1996年1月至2009年12月在华西医院住院治疗合并足部感染的507例糖尿病足患者的资料,对溃疡处分离出的532株细菌进行病原菌分布及耐药性分析.两组间计数资料比较采用X2检验.结果 纳入的共662例患者中,507例（76.6%）存在足部感染,358例（70.6%）患者足部溃疡处分离出532株细菌.糖尿病足部感染最常见的病原菌为革兰阳性菌（G＋菌）281株（52.8%）,其次为革兰阴性菌（G-菌）206株（38.7%）,真菌45株（8.5%）.136例（26.6%）存在混合感染.G＋菌中主要有金黄色葡萄球菌（89株,16.7%）,粪肠球菌（48株,9.0%）,表皮葡萄球菌（43株,8.1%）,发现3株耐万古霉素肠球菌,10株耐甲氧西林金黄色葡萄球菌.G＋菌对氨曲南（87.7%）、红霉素（83.5%）、头孢曲松（83.2%）及青霉素（81.0%）耐药率较高,对万古霉素（2.1%）和氟哌酸（15.3%）耐药率较低;G-菌主要有大肠埃希菌（34株,6.4%）,阴沟肠杆菌（23株,4.3%）,普通变形杆菌（21株,3.9%）和肺炎克雷伯菌（21株,3.9%）;G-菌对氨苄青霉素的耐药率最高（90.2%）,其次为氨苄青霉素/青霉烷砜（75.3%）、利福平（72.5%）、青霉素（66.7%）和红霉素（60.8%）;对亚胺培南（7.8%）、丁胺卡那霉素（12.4%）和头孢泊肟（15.7%）的耐药性较低.真菌主要为白色念珠菌（13株,2.4%）.结论糖尿病足溃疡处G＋菌的感染率较G-菌高,万古霉素及亚胺培南具有较高抗菌活性.细菌耐药形势严峻,应合理使用广谱抗生素,并对细菌的耐药性进行监测.     

Bacteriology of bronchial secretions in non-tubercular lower respiratory tract infections

Fifty samples of bronchial secretions collected from patients of non-tubercular lower respiratory tract infections through fiberoptic bronchoscopy (FOB) were cultured both for aerobic and anaerobic organisms. Thirty-three (66%) samples yielded bacteria. Out of these, thirty were isolated in pure culture and from three, a mixed growth of aerobic and anaerobic micro-organisms was obtained. Aerobic bacteria were the predominant isolates. Stephylococcus aureus (10), pseudomonas (9) and streptococcus pneumoniae (8) were the major aerobic isolates. Ciprofloxacin was found to be the most effective drug against aerobes and metronidazole against anaerobes in vitro susceptibility tests.     

晚期肺癌化疗后下呼吸道感染31例临床分析

目的 分析晚期肺癌化疗后下呼吸道感染的致病菌种类和药敏结果,正确选择抗菌素。方法对３１例确诊为肺癌并且出现化疗后下呼吸道感染患者,进行致病菌和药物敏感性分析。结果 ３１例菌株中,革兰氏阴性杆菌２９株（９３．５％）,其中肺炎克雷伯氏杆菌１４株,硝酸盐阴性杆菌１０株。对上述两种杆菌,阿米卡星和亚胺培南１００％敏感,庆大霉素、环丙沙星和头孢他啶敏感性亦较高。结论 了解肺癌患者化疗后引起下呼吸道感染的致病     

利福昔明在消化疾病中的临床应用进展

利福昔明(Rifaximin)是利福霉素衍生物,对多种革兰阳性、革兰阴性需氧菌和厌氧菌均有高度抗菌活性,是治疗大肠埃希菌所致旅游者腹泻的一种新药.口服不易被肠道吸收,在肠道内有较高浓度,全身不良反应轻微是其特点.近年来利福昔明在肝性脑病、肠内胀气及肠道气体相关性疾病、憩室病、肠内细菌过度生长、炎症性肠病(IBD)以及幽门螺杆菌感染(H pylori)的根除等疾病治疗中应用日趋广泛并取得了较好疗效.     

Bacteriology of the bile in cholecystopathies. Radiological association

A clinicobacteriological survey was undertaken in 55 patients undergoing biliary surgery, because of chronic and acute cholecystitis. Some radiological preoperative and operative aspects were analised in order to detect any relation of these aspects with biliary tract infection. The bile cultures were positive in 34,5% and 20,0% for aerobes an anaerobes microorganisms respectively. The microorganisms most frequently isolated were Escherichia coli, Pseudomonas aeruginosa, Klebsiella, Bacteroides sp and Clostridium sp, as aerobian and anaerobian. The statistical analysis showed significance between the presence of bacteria in the biliary tract and pathological operative cholangiography. It had not significance with the radiological preoperative aspects.