Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia
Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia
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DOI：
10.1097/00043426-199909000-00018
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发表时间：
1999-09-01
影响因子：
1.2
通讯作者：
Ribeiro, PC
中科院分区：
文献类型：
--
作者：
Arnaout, MK;Tamburro, RF;Ribeiro, PC
目的：溶血很少与蜡样芽孢杆菌败血症相关，只有两个非常有据可查的病例报告。本文报告了两个不寻常的情况下，蜡状芽孢杆菌败血症与大量的血管内溶血的患者谁有急性淋巴细胞白血病（ALL）。患者和方法：一个20岁的妇女谁是9周的怀孕经历了复发的ALL。进行了治疗性流产。在再次诱导的第4周，患者出现腹痛、恶心和呕吐，伴重度中性粒细胞减少，但无发热。她的病情迅速恶化，出现心血管性虚脱、急性大量血管内溶血，并在症状出现后数小时内死亡。血培养呈蜡样芽孢杆菌阳性。尸检组织学检查和培养显示多个器官中存在蜡样芽孢杆菌和白色念珠菌。第二名患者是一名10岁的女孩，患有复发性T细胞ALL。在再诱导的第二周，她出现腹痛，随后出现低血压。同样，未观察到发热。实验室检查显示入院后12小时出现血管内溶血。积极的支持迅速启动。尽管弥散性血管内凝血，心血管，肝，肾功能衰竭，和多个脑内低密度病变被认为是梗死，病人完全康复，并恢复reinduction therapy.Conclusions：蜡样芽孢杆菌感染可能有一个暴发性的临床过程，可能是复杂的大规模血管内溶血。在出现胃肠道症状的免疫抑制患者中应怀疑该病原体，并且不应因无发热而排除，特别是如果正在给予类固醇如地塞米松。在蜡样芽孢杆菌败血症伴大量溶血时，换血可能是救命的。
Purpose: Hemolysis is so rarely associated with Bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of Bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL).Patients and Methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for Bacillus cereus. Postmortem histologic examination and cultures revealed Bacillus cereus and Candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy.Conclusions: Bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in Bacillus cereus septicemia associated with massive hemolysis.