Community-acquired Klebsiella pneumoniae bacteremia with meningitis and endophthalmitis in Italy.
Community-acquired Klebsiella pneumoniae bacteremia with meningitis and endophthalmitis in Italy.
复制标题
DOI：
10.1016/s1201-9712(03)90060-9
复制
发表时间：
2003-09-01
期刊：
影响因子：
--
通讯作者：
Vaglia, Alberto
中科院分区：
文献类型：
--
作者：
Giobbia, Mario;Scotton, Pier Giorgio;Vaglia, Alberto
监测研究支持这样一种看法，即社区获得性肺炎在西方国家不再是一个重要的实体。同样，以菌血症合并肝脓肿、眼内炎或脑膜炎为特征的独特的社区获得性肺炎克雷伯氏菌综合征迄今几乎只在亚洲有报道。我们在此提出另一例肺炎克雷伯菌血症合并脑膜炎和眼内炎的病例，据我们所知，这是意大利的第一例报告。一位有胰岛素依赖型糖尿病病史的50岁男性患者在连续4天发热、头痛、恶心后住进我科。中度颈部僵硬，持续发热（38℃）。胸部x光呈阴性。入院后不久，患者进入深度昏迷状态。颅脑计算机断层扫描（CT）未显示局灶性病变。腰椎穿刺发现脑脊液混浊，蛋白含量高（369 mg/dL），白细胞含量高（3025/mL，以多形核白细胞为主）。血清和脑脊液葡萄糖浓度分别为417和100 mg/dL。脑脊液革兰氏染色显示大量革兰氏阴性杆菌。由于严重呼吸衰竭的发展，患者被转到重症监护室，在那里他插管和机械通气。接着胸部出现点疹。实验室检查显示：血小板22000 /mm3，白细胞9670/mm3，肝转氨酶水平升高至正常上限的4倍。开始了头孢噻肟、氨苄西林和左氧氟沙星的经验性肠外治疗。同时静脉注射地塞米松，每6小时4毫克。住院第3天，肺炎克雷伯菌在脑脊液培养物和3个血培养物中生长。因此停用氨苄西林，抗生素治疗改为静脉注射头孢噻肟、培氟沙星和美罗培南。意大利特雷维索丰切罗医院感染性疾病科、重症监护科和文化科。
Surveillance studies support the perception that community-acquired pneumonia is no longer an important entity in Western countries. Likewise, a distinctive community-acquired Klebsiella pneumonia syndrome characterized by the presence of bacteremia in conjunction with liver abscess, endophthalmitis or meningitis has been, to date, almost exclusively described in Asia. We present here a further case of K. pneumoniae bacteremia in conjunction with meningitis and endophthalmitis that is, to our knowledge, the first report from Italy. After 4 days of remittent fever, headache, and nausea, a 50-year-old man with a history of insulin-dependent diabetes mellitus was admitted to our department. Moderate nuchal rigidity and continuous fever (38 C) were present. Chest X-ray was negative. Shortly after admission, the patient entered a deep coma state. Cranial computed tomography (CT) did not show evidence of focal lesions. A lumbar puncture yielded cloudy cerebrospinal fluid (CSF) with high levels of proteins (369 mg/dL) and white blood cells (WBCs)(3025/mL, with a predominance of polymorphonuclear leukocytes). Serum and CSF glucose concentrations were 417 and 100 mg/dL, respectively. CSF Gram staining revealed a large number of Gramnegative bacilli. Because of the development of severe respiratory failure, the patient was referred to the intensive care unit, where he was intubated and mechanically ventilated. A petechial rash on the chest followed. Laboratory investigations revealed: platelets 22 000/mm3, WBC 9670/mm3, and hepatic aminotransferase levels elevated to four times the upper limit of normal. Empirical parenteral treatment with cefotaxime, ampicillin and levofloxacin was initiated. Intravenous dexamethasone, 4 mg every 6 h, was also added. On hospital day 3, K. pneumoniae grew in cultures of CSF and in three blood cultures. Ampicillin was therefore discontinued, and antibiotic treatment changed to intravenous cefotaxime, pefloxacin, and meropenem. On (lhfectious Disease Department, Wntensive Care Department, and (3) 0culistic Department, OC CB Foncello, Treviso, Italy.