A first report of pulmonary melioidosis in Cambodia.
A first report of pulmonary melioidosis in Cambodia.
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DOI：
10.1016/s0035-9203(08)70007-5
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发表时间：
2008-12-01
影响因子：
2.2
通讯作者：
Vong, Sirenda
中科院分区：
文献类型：
--
作者：
Overtoom, Rob;Khieu, Virak;Vong, Sirenda
柬埔寨从未正式报告过类鼻疽病。在此我们报告两个病例，一位58岁男性（病例1）和一位49岁女性（病例2），他们以呼吸道疾病为特征，表现为多发性肺气肿。在对柬埔寨南部住院患者（亚）急性呼吸道感染的病原学进行的一项基于实验室的研究框架内，对两名患者进行了痰培养，结果均培养出类鼻疽伯克霍尔德菌。这些病例故事中最引人注目的方面是诊断延误的程度。病例1有1个月的呼吸道症状史，最初被怀疑感染结核病，后来在柬埔寨金边被误诊为“转移性肺癌”。例2患肺部感染10年以上，曾4次因结核病治疗。两例患者均未产生抗酸杆菌（AFB）阳性痰。在我们的实验室确认后，对患者进行了重新入院的追踪。在“经典”的甲氧苄啶磺胺甲恶唑，氯霉素和强力霉素治疗，他们的临床状况在2周内得到了相当大的改善。这两个研究病例说明了柬埔寨类鼻疽误诊的相关问题;临床医生对这种疾病不熟悉，这与结核病的高患病率有关。因此，提高临床医生对类鼻疽的认识将对公共卫生产生重大影响，因为这种疾病的非败血症形式可能可以用柬埔寨公立医院提供的抗生素治疗。
Melioidosis has never been officially reported from Cambodia. Here we report two cases, a 58-year-old male (case 1) and a 49-year-old female (case 2) who presented with respiratory illnesses featuring multiple lung abscesses. The sputum culture of both patients, taken in the framework of a laboratory-based study on aetiologies of (sub-)acute respiratory infections among hospitalized patients in southern Cambodia, grew Burkholderia pseudomallei. The most striking aspect of these case stories was the extent of the delays in diagnosis. Presenting with a 1-month history of respiratory symptoms, case 1 was first suspected of tuberculosis (TB) infection, and then misdiagnosed as 'metastatic lung cancer' in Phnom Penh, Cambodia. Case 2 suffered from pulmonary infections for >10 years, during which time she was treated for TB four times. Neither patient ever produced acid-fast-bacilli (AFB)-positive sputum. Following our laboratory confirmation, the patients were traced for re-admission. Under the 'classical' trimethoprim sulphamethoxazole, chloramphenicol and doxycycline treatment, their clinical status improved considerably within 2 weeks. The two study cases illustrate issues relating to the misdiagnosis of melioidosis in Cambodia; an unfamiliarity of clinicians with the disease, which is associated with a high prevalence of TB. Therefore, a heightened awareness of melioidosis among clinicians would have a substantial impact on public health as the non-septicaemic form of the disease is potentially treatable with antibiotics that are available in Cambodian public hospitals.