1例痰液戈登菌致血流感染误诊中毒性红斑病例分析

目的 通过对1例痰液戈登菌致血流感染误诊为中毒性红斑病例的回顾性分析,为微生物室工作人员和临床医生提供诊疗经验。方法 患者入院后进行痰培养和血培养,血培养有细菌生长,根据血培养结果改用美罗培南联合阿米卡星抗感染治疗。血培养分离菌用杭州滨河微量生化管,梅里埃VITEK2的NH试条,梅里埃VITEK MS和16SrRNA基因测序进行细菌鉴定。结果 痰培养报告有呼吸道正常菌群生长。血培养检出生长缓慢、革兰阳性、弱抗酸性棒状杆菌。氧化酶阴性,触酶阳性。梅里埃VITEK2的NH试条检测提示为无法鉴定的细菌; VITEK MS质谱仪鉴定为戈登菌属;16SrRNA基因测序结果显示该菌与痰液戈登菌的相似度为99%（GenBank登录号为KY319045.1）。临床最终明确诊断为痰液戈登菌性血流感染,应用美罗培南联合阿米卡星治疗10 d,患者症状消除、血培养转阴。结论 痰液戈登菌可引起血流感染,应用美罗培南联合阿米卡星治疗有效。该病可出现发热咳嗽伴红色片状皮疹的症状,临床应注意与中毒性红斑鉴别。痰液戈登菌用常规微生物鉴定仪无法鉴定,质谱仪只能鉴定到戈登菌属,建议积极进行16SrRNA基因测序,以便早日诊断和治疗。

A case of bloodstream infection caused by Gordonia in sputum misdiagnosed as toxic erythema

Objective A case of bloodstream infection caused by Gordonia in sputum misdiagnosed as toxic erythema was analyzed retrospectively, so as to provide diagnosis and treatment experience for microbiological staff and clinicians. Methods Retrospective analysis of cases: sputum culture and blood culture were carried out after admission. Bacteria grew in blood culture. Meropenem combined with amikacin was used for anti infection treatment according to the results of blood culture. The isolated bacteria were identified by Hangzhou Binhe micro biochemical tube, NH test strip of merier VITEK 2, merier VITEK MS and 16S rRNA gene sequencing. Results Sputum culture reported normal growth of respiratory tract flora. Slow growth, gram positive and weak acid resistant Corynebacterium were detected in blood culture. The oxidase was negative and the touch enzyme was positive. The NH test strip of merier VITEK2 showed that it was an unidentified bacterium; VITEK MS mass spectrometer identified as Gordonia; The 16S rRNA gene sequencing results showed that the similarity between the strain and Gordonia sputum was 99% (GenBank accession number was KY319045.1). The final clinical diagnosis was sputum Gordonia bloodstream infection. Meropenem combined with amikacin was used for 10 days. The symptoms of the patient were eliminated and the blood culture turned negative. Conclusion Gordonia in sputum can cause bloodstream infection. Meropenem combined with amikacin is effective. The symptoms of fever, cough and red flaky rash may appear in this disease. It should be differentiated from toxic erythema clinically. It is suggested that 16S rRNA gene sequencing should be actively carried out for early diagnosis and treatment.