海南省乐东县类鼻疽病的临床及微生物特征

目的 通过总结乐东地区类鼻疽病的临床和微生物学特征,为临床类鼻疽病的诊断和治疗提供科学依据。方法 通过病例查询回顾性分析2018年8月—2020年9月就诊于乐东县人民医院的类鼻疽病患者,采用生化反应鉴定疑似菌种,对生化鉴定为类鼻疽伯克霍尔德菌的菌种,采用全基因组测序方法复核鉴定结果;使用微量肉汤稀释法检测致病菌和抗生素的敏感性。结果 14例类鼻疽患者均有糖尿病史,患者在6—9月发病占71.43%;男性占78.57%;50~65岁占71.43%;农民占78.57%;临床表现以败血症为主,占92.86%。细菌培养48 h后菌落由湿润、凸起变干燥、扁平,镜下呈中央淡染、两端浓染的特征。生化鉴定为类鼻疽伯克霍尔德菌的菌株经全基因测序复核结果均一致。药敏试验显示致病菌对头孢他啶、亚胺培南、美罗培南、复方磺胺甲噁唑全敏感;14例患者治愈或好转10例,死亡4例,病死率28.57%。结论 类鼻疽高发于台风季节,男性糖尿病农民为高危人群,且易发展为败血症而死亡,临床医生特别是基层医生应提高对类鼻疽病认知,做到早发现、早诊断、早治疗。

Clinical and microbiological characteristics of melioidosis in Ledong,Hainan

Objective To provide a scientific basis for diagnosis and treatment of melioidosis by summarizing the clinical and microbiological characteristics of meilioidosis Burkholderia pseudomallei in Ledong area. Methods Retrospective analysis was conducted to summarize and analyze the information of melioidosis cases in Ledong Li ethnic minority area, Hainan Province from August 2018 to September 2020. Suspected strains were identified by biochemical reactions, and to those identified as Burkholderia pseudomallei, were re-identified by whole-genome sequencing; Micro broth dilution method was used to detect the susceptibility of Burkholderia pseudomallei to antibiotics. Results All the 14 melioidosis patients had diabetes; 71.43% showed symptoms between June and September; 78.57% were male; 78.57% were farmers; 71.43% of the patients aged between 50 and 65 years old. Septicemia was the most common clinical manifestations, accounted for 92.86%; Bacteria were cultured for 48 h, the colonies changed from moist, convex to dry, flat, and the bacteria showed dense staining at both ends and light staining in the middle section under the microscope. The biochemical identification of Burkholderia pseudomallei was consistent with whole genome sequencing. The pathogen was susceptible to ceftazidime, imipenem, meropenem, and compound sulfamethoxazole. For clinical outcome, 10 cases were cured or improved, 4 were dead, the mortality rate was 28.57%. Conclusion Melioidosis occurs frequently in the typhoon season. Male diabetic farmers are a high-risk group and are prone to develop sepsis and die. Clinicians, especially primary care doctors, should improve their awareness of melioidosis so as to achieve early detection, early diagnosis, and early treatment.