35例类鼻疽病例临床特点分析

目的分析类鼻疽的临床特点,并探讨其诊断及治疗的方法。方法回顾性分析某院2012年3月—2017年2月收治的有明确病原学依据的35例类鼻疽患者。结果 35例类鼻疽患者在入院时2例(5.7%)因有外院培养结果而确诊,3例(8.6%)高度疑似患者主要有相对典型的临床特点,误诊30例(85.7%),疑似患者入院后均经各种标本培养检出类鼻疽伯克霍尔德菌确诊;采用抗感染、外科穿刺引流(11.4%)及手术(20.0%)治疗,病情好转或痊愈26例(74.3%),放弃治疗2例(5.7%),死亡7例(20.0%)。临床首发症状以发热(88.6%)最常见,其次为咳嗽(34.3%)、气促(28.6%)、腹痛(14.6%)、上下肢痛(11.4%)、关节痛(5.7%);感染部位居前五位的分别为血液(85.7%)、肺(54.3%)、脾(20.0%)、皮肤软组织(20.0%)、肝(14.3%);以血培养出类鼻疽伯克霍尔德菌最为常见,占85.7%,其次为各种穿刺液(37.1%)、痰(20.0%)。结论类鼻疽的临床特点复杂多样,误诊率高,早期确诊和及时、合理、足疗程的治疗可降低病死率和复发率。

Clinical features of 35 cases of melioidosis

ObjectiveTo analyze the clinical features of melioidosis， explore its diagnosis and treatment methods. Methods35 patients who were with pathogenic evidence of melioidosis and admitted in a hospital between March 2012 and February 2017 were analyzed retrospectively. ResultsOf 35 patients at admission, 2 (5.7%) were with confirmed culture result of melioidosis in the other hospitals, 3 (8.6%) highly suspected patients had relatively typical clinical features, 30 (85.7%) were misdiagnosed, suspected patients were all confirmed melioidosis through the cultured result of Burkholderia pseudomallei from all kinds of specimens. Through treatment of anti infection, surgical drainage (11.4%) and operation (20.0%), 26 cases (74.3%) were improved or recovered, 2 (5.7%) abandoned treatment, and 7 (20.0%) died. The most common initial symptom was fever (88.6%), followed by cough（34.3%）, shortness of breath（28.6%）, abdominal pain (14.6%), extremity pain (11.4%), and joint pain (5.7%); the top five infection sites were blood (85.7%), lung (54.3%), spleen (20.0%), skin and soft tissue (20.0%), and liver (14.3%); 85.7% of Burkholderia pseudomallei were isolated from blood culture, 37.1% and 20.0% were isolated from all kinds of puncture fluid and sputum respectively. ConclusionClinical features of melioidosis are diverse, misdiagnosis rate is high. Early, timely, rational, and enough treatment course can reduce the mortality and recurrence rate of melioidosis.