Rapidly progressive fatal pneumococcal sepsis in adults: a report of two cases
Rapidly progressive fatal pneumococcal sepsis in adults: a report of two cases
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DOI：
10.1007/s10156-007-0547-2
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发表时间：
2007-10-01
影响因子：
2.2
通讯作者：
Yamazaki, Yoshihiko
中科院分区：
文献类型：
--
作者：
Iinuma, Yasushi;Hirose, Yasuo;Yamazaki, Yoshihiko
我们报告两例迅速进行性致命的压倒性肺炎球菌感染。患者1是一名67岁的男性，有24小时的发热和不适病史，并被转移到我科。他病得很重，呼吸急促，感到发冷。全身皮肤出现紫癜性变色伴瘀斑。胸部X线检查结果显示右下肺野支气管血管束增厚，随后显示存在支气管扩张症。实验室检查显示存在代谢性酸中毒和弥散性血管内凝血。就诊后，病情迅速恶化，随后发生心肺骤停。尽管进行了心肺复苏，但患者在就诊后仅3小时死亡。从患者血液中分离的菌株显示青霉素敏感的肺炎链球菌，血清型4。患者2是一名30岁的女性，既往有无意外妊娠史，因发热、恶心、头痛和不适2天而转入我科。虽然她当时怀孕19周，但她在入院前流产了。在我科就诊时，她表现出生命体征不稳定、意识减退、无尿和黄疸。在她身体的大部分，包括远端四肢，发现皮肤出现紫癜性变色和瘀斑。胸部X线检查结果接近正常。最初的实验室研究显示存在严重的代谢性酸中毒和弥散性血管内凝血伴多器官衰竭。尽管积极的心肺支持，正常的神经反应消失后第2天入院，病人在入院后第16天死亡。患者的血液和阴道拭子分离物后来都显示青霉素敏感的肺炎链球菌，血清型12F。快速进展的感染性休克的表现应引起治疗医生对压倒性肺炎球菌感染的怀疑，这种感染的治疗选择有限。
We report two cases of a rapidly progressive fatal overwhelming pneumococcal infection. Patient 1 was a 67-year-old man with a 24-h history of fever and malaise and was transferred to our department. He was severely ill, tachypneic, and felt a chill. A purpuric discoloration with ecchymosis of the skin was noted over the body. The chest X-ray findings demonstrated thickening of the bronchovascular bundle in the right lower lung field, which later revealed the presence of bronchopneumonia. Laboratory studies revealed the presence of metabolic acidosis and disseminated intravascular coagulation. After presentation, rapid deterioration occurred followed by cardiopulmonary arrest. Despite cardiopulmonary resuscitation, the patient died only 3h after presentation. The isolates from the patient's blood revealed penicillin-susceptible Streptococcus pneumoniae, serotype 4. Patient 2 was a 30-year-old woman with a prior history of uneventful pregnancies was transferred to our department with a 2-day history of fever, nausea, headache, and malaise. Although she was in the 19th week of pregnancy at the time, she suffered a miscarriage just prior to admission. Upon presentation to our department, she demonstrated unstable vital signs, diminished consciousness, anuria, and icterus. Purpuric discoloration with ecchymosis of the skin was noted in over most of her body, including the distal extremities. The chest X-ray findings were close to normal. Initial laboratory studies revealed the presence of severe metabolic acidosis and disseminated intravascular coagulation with multiple organ failure. Despite aggressive cardiopulmonary support, normal neurological responses disappeared on the 2nd day following admission and the patient died on the 16th day after admission. The patient's isolates from blood and vaginal swabs both later revealed penicillin-susceptible Streptococcus pneumoniae, serotype 12F. The presentation of rapidly progressive septic shock should raise the treating physician's suspicion of overwhelming pneumococcal infection, which has limited management options.