Rhodococcus equi: pulmonary cavitation lesion in patient infected with HIV cured by levofloxacin and rifampicin.
Rhodococcus equi: pulmonary cavitation lesion in patient infected with HIV cured by levofloxacin and rifampicin.
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马红球菌：左氧氟沙星和利福平治愈的艾滋病毒感染者的肺空洞病变。
DOI：
10.1097/00002030-200207050-00026
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
G. Carosi
中科院分区：
文献类型：
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作者：
F. Moretti;E. Quiros;S. Casari;P. Viale;A. Chiodera;G. Carosi
在高效抗逆转录病毒疗法（HAART）可用之前，我们诊所进行的一项研究[1]表明，抗生素治疗通常无法根除HIV感染患者的马红球菌感染，尽管在大多数情况下可以观察到临床改善。一个R.最近在2月号的这份杂志中描述了一名HIV患者的马肺炎，通过肺叶切除术和持续抗生素治疗伴随HAART而消退[2]。然而，对于肺部或全身R没有标准的治疗方案。马感染，在治疗过程中需要仔细和反复的培养和敏感性测试，以确定获得性耐药性。一名34岁的男子被收住到我们的诊所，患有发烧（39 ℃），胸部疼痛辐射到右肩和咳嗽持续一个月，当他被发现是HIV感染。他是一个重度吸烟者，直到几年前还在静脉注射毒品。胸部X线检查显示右肺小舌附近肺泡浸润伴空洞性病变（直径2 cm）（图1），经断层扫描对照证实，并显示空洞与胸膜接触。血液的实验室研究显示以下数值：白色血细胞计数：5.9/ml;血红蛋白：11.2 g/dl;红细胞计数：3300/ml;红细胞沉降率：109; C反应蛋白：30.9; CD 4淋巴细胞：21个细胞/mm 3;和HIV-RNA水平：91 000拷贝/ml。血液、粪便和痰标本常规培养均为R.马只对环丙沙星、氨基葡萄糖苷类、亚胺培南、利福平、万古霉素敏感。支气管刷检和支气管镜检查证实了微生物诊断，并显示肉芽肿性炎症伴干酪样坏死。
A study conducted in our clinic before highly active antiretroviral therapy (HAART) was available [1] demonstrated that antibiotic treatment is usually unable to eradicate Rhodococcus equi infection in HIV-infected patients, although a clinical improvement could be observed in most cases. A case of R. equi pneumonia in an HIV patient resolved by lobectomy and continuous antibiotic therapy concomitant with HAART has recently been described in the February issue of this journal [2]. However, there is no standard treatment protocol for pulmonary or systemic R. equi infections, and careful and repeated culture and susceptibility testing during treatment is required to determine acquired resistance.A 34-year-old man was admitted to our clinic suffering from fever (39 C), thoracic pain irradiating to the right shoulder and cough lasting for one month, when he was discovered to be HIV infected. He was a heavy smoker and had used intravenous drugs until a few years ago. Chest X-ray showed an alveolar infiltrate with a cavitary lesion (diameter 2 cm) near the lingula of the right lung (Fig. 1), which was confirmed by a tomographic control and showed the contact of the cavity with the pleura. Laboratory studies of blood showed the following values: white blood cell count: 5.9/ml; haemoglobin: 11.2 g/dl; red blood cell count: 3300/ml; erythrocyte sedimentation rate: 109; C-reactive protein: 30.9; CD4 lymphocytes: 21 cells/mm 3; and HIV-RNA level: 91 000 copies/ml. Routine cultures of the blood, faecal and sputum specimens yielded R. equi, which was only susceptible to ciprofloxacin, aminoglucosides, imipenem, rifampin and vancomycin. Bronchial brushing and bronchoscopy confirmed the microbiological diagnosis and showed a granulomatous inflammation with caseating necrosis.