Lung abscess and pleuritis caused by Lactobacillus rhamnosus in an immunocompetent patient
Lung abscess and pleuritis caused by Lactobacillus rhamnosus in an immunocompetent patient
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DOI：
10.1007/s10156-009-0004-5
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发表时间：
2010-02-01
影响因子：
2.2
通讯作者：
Niki, Yoshihito
中科院分区：
文献类型：
--
作者：
Shoji, Hisashi;Yoshida, Koichiro;Niki, Yoshihito
一名 79 岁男性因左胸痛和 38.0 至 38.9A 度的发烧来就诊。胸部计算机断层扫描显示左舌段有肿块病变（Φ 40 毫米），炎症标志物升高。他被诊断为肺脓肿入院，并以 2 g/天的剂量给予帕尼培南/倍他米隆，之后症状略有短暂缓解。然而，住院第八天，他的体温再次升高，达到39.0A摄氏度以上，胸片显示并发症为胸膜炎。抗生素改为替考拉宁（TEIC；400 mg/天）和美罗培南（2.0 g/天）。同时开始胸腔引流和胸腔灌洗。乳杆菌属经培养从胸腔积液中检出大肠杆菌，认为其为致病菌，且对 TEIC 具有耐药性。因此，将抗生素改为细菌敏感的克林霉素。没有观察到随后的发烧或胸腔积液。患者病程良好，于住院第45天出院。随后，通过16s rRNA序列鉴定出致病微生物为鼠李糖乳杆菌。鼠李糖乳杆菌很少对人类致病。鼠李糖乳杆菌感染多发生在免疫抑制的患者中，仅有少数病例报道于免疫功能正常的患者中。在本例中，患者没有免疫缺陷；然而，由于肺气肿，他的肺部局部免疫系统受损。
A 79-year-old man consulted us because of left chest pain and fever ranging from 38.0 to 38.9A degrees C. A chest computed tomography scan showed a mass lesion (phi 40 mm) in the left lingular segment, and inflammatory markers were elevated. He was admitted with a diagnosis of lung abscess, and panipenem/betamipron was administered at a dose of 2 g/day, after which the symptoms showed slight transient resolution. However, his body temperature increased again, to more than 39.0A degrees C, on the eighth day of hospitalization, and a chest radiograph suggested pleuritis as a complication. The antibiotics were changed to teicoplanin (TEIC; 400 mg/day) and meropenem (2.0 g/day). Thoracic drainage and pleural lavage were initiated at the same time. Lactobacillus spp. was detected from the pleural effusion by culture and was considered to be the causative organism, and it was resistant to TEIC. Therefore, the antibiotic was changed, to clindamycin, to which the bacteria was susceptible. No subsequent fever or pleural fluid retention was observed. The patient's course was good, and he was discharged on day 45 of hospitalization. Subsequently, the causative organism was identified as Lactobacillus rhamnosus by the 16s rRNA sequence. Lactobacillus rhamnosus is rarely pathogenic in humans. Lactobacillus rhamnosus infection mostly occurs in immunosuppressed patients, and only a few cases have been reported in immunocompetent patients. In the present case, the patient was not immunodeficient; however, his lung had an impaired local immunosystem, due to emphysema.