[A negleted bacteria with a case: Bartonella henselae].
[A negleted bacteria with a case: Bartonella henselae].
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[一种被忽视的细菌：汉塞巴尔通体]。
DOI：
10.5578/mb.57321
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发表时间：
2017
影响因子：
1
通讯作者：
Saniye Dolhan
中科院分区：
文献类型：
--
作者：
K. Türker;B. Çelebi;Ş. Andaç;P. Bulut;S. Yalçin;Saniye Dolhan
亨selbartonella henselae是猫抓病（CSD）的病原体，是一种革兰氏阴性，球芽孢杆菌，兼性细胞内细菌CSD通常表现为临床形式的良性局部淋巴结病（LAP），但有时可能发展为严重的危及生命的并发症。CSD是一种常见病，是世界范围内引起局部lap的重要原因之一，但在我国却鲜有相关报道。对于诊断，临床医生应该怀疑CSD，并询问患者是否有猫抓伤的故事。在我国，CSD的诊断通常是通过侵入性病理检查，而不是简单的血清学检查。本文报道1例14岁的CSD患者，经间接荧光抗体（IFA）法检测血清中抗体滴度为1/384 IgM， 1/2048 IgG henselae抗体，经聚合酶链反应（PCR）检测腋窝LAP患者LAP标本中henselae抗体阳性。尽管分子技术已被用于先前报告病例的诊断，但这是我国第一例用PCR检测到的亨selae阳性病例。在病例史中了解到，患者几个月前被街猫抓伤，4-5周后出现腋窝LAP。腋窝超声显示脓肿，最大22 × 44 mm，符合LAP。LAP活检标本培养未见生长。白细胞计数正常，但沉降速率（68 mm/h）和c反应蛋白（41.7 mg/L）较高。治疗开始时使用阿奇霉素500 mg/天，但两周后由于LAP没有消退，考虑到耐药性的发展，改为强力霉素2 × 100 mg/天和利福平1 × 300 mg/天。由于LAP处于脓肿形成阶段，且IFA检测到的滴度高于B.henselae抗体滴度对心内膜炎的预测值，因此治疗时间延长至四周，患者已治愈。在我国，由于从农村大量移民到城市以及与街头动物无意识和不受控制的友谊生活，儿童和青少年受到宠物传播的人畜共患疾病感染的风险非常高。我们应该接受这不是一种罕见的情况，因为猫抓病可以从无害转变为非常严重的形式，诊断和治疗应该迅速而仔细地进行。目前，我国一些参考实验室很少对巴尔通体进行血清学检测。这些实验室的数量应该增加，或者至少应该扩大这些参考实验室中检测方法的使用。
Bartonella henselae the causative agent of cat scratch disease (CSD), is a gram-negative, coccobacillus, facultative intracellular bacterium CSD usually presents as a clinical form of benign local lymphadenopathy (LAP) but sometimes it may progress to severe life threatening complications. Despite the fact that CSD is known to be a common disease, which is one of the important causes of local LAPs in the world, there are few publications in our country. For the diagnosis, the clinician should suspect for CSD and has to ask to the patient whether there is a story of cat scratch or not. In our country the diagnosis of CSD is usually done by invasive pathological examination instead of simple serological tests. In this report, a 14 years old case with CSD with antibody titers of 1/384 IgM, 1/2048 IgG B.henselae antibody determined by indirect fluorescent antibody (IFA) method in serum and B.henselae positivity by polymerase chain reaction (PCR) from LAP sample of the patient with axillary LAP was presented. Even though molecular techniques have been used for the diagnosis of the previous reported cases, it is the first B.henselae positive case in our country detected with PCR. In the history of the case it was learned that the patient was scratched by a street cat few months ago and the axillary LAP developed 4-5 weeks later. Axillary ultrasonography shawed abscesses with the largest 22 x 44 mm compatible with LAP. No growth was detected in the LAP biopsy specimen culture. Leucocyte count was normal but sedimentation rate (68 mm/h), and C-reactive protein (41.7 mg/L) were higher.Therapy was started with azitromycin 500 mg/day but two weeks later as there was no regression of LAP, considering the development of resistance, the treatment was changed to doxycycline 2 x 100 mg/day and rifampicin 1 x 300 mg/day. As the LAP was in abscess formation and the titers found in IFA was higher than the predictive value of B.henselae antibody titer for endocarditis, the treatment has been extended to four weeks and the patient has been cured. Especially children and adolescents are at very high risk for zoonotic infections transmitted from pets in our country due to the intense immigration to the city from the rural areas and the unconscious and uncontrolled livelihood of friendship with street animals. We should accept that this is not a rare condition, as the cat scratch disease can change from harmless to very serious forms the diagnosis and treatment should be quickly and carefully performed. Currently, serological examinations for Bartonella are rarely done in some certain reference laboratories in our country. The number of these laboratories should be increased or the usage of the tests in these reference laboratories should be at least expanded.