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題 名 | Pyomyositis, Deep Neck Infection and Brain Abscess Caused by Klebsiella Pneumoniae in a Non-diabetic Patient=克雷伯氏菌在一位非糖尿病病人引起的膿肌炎症、深頸部感染及腦膿瘍 |
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作 者 | 廖俊正; 蔡哲安; 廖妙淯; 林宜君; 唐憶淨; 李祥煒; 陳順天; | 書刊名 | 臺灣老年醫學暨老年學雜誌 |
卷 期 | 3:3 2008.08[民97.08] |
頁 次 | 頁222-229 |
分類號 | 415.15 |
關鍵詞 | 膿肌炎症; 深頸部感染; 腦膿瘍; 克雷伯氏菌; 肝硬化; Pyomyositis; Deep neck infection; Brain abscess; Klebsiella pneumoniae; Liver cirrhosis; |
語 文 | 英文(English) |
中文摘要 | 克雷伯氏菌在非糖尿病病人造成的膿肌炎症及深頸部感染在台灣很 少見。鏈球菌及克雷伯氏菌是社區型腦膿瘍的主因,但克雷伯氏菌造成 的腦膿瘍常是因肝臟膿瘍而來的。本病例是一個59歲非糖尿病患但有慢 性C型肝炎的病史。此次因為右下肢及右下頷紅、腫、熱、痛及發燒一星 期而求診。右下肢及頸部電腦斷層診斷為膿肌炎症及深頸部感染。病患 於住院間接受右下肢筋膜切開併清創手術及右下頷接受切開引流手術。 而血中及抽出之膿菌的細菌培養均為克雷伯氏菌。腹部超音波發現有肝 硬化但無肝膿瘍。一開始使用每天3次cefotaxime 抗生素治療,但在住院 的第10天頸部電腦斷層診斷追蹤檢查偶然發現有多發性腦膿瘍,經神經 外科腦部穿刺,並無細菌、黴菌或分枝桿菌之發現。因為屬中樞神經感 染,我們把 cefotaxime 劑量加大為每天4次。在完整的抗生素治療後, 追蹤腦部的電腦斷層診斷發現腦膿瘍的大小明顯減少,最後在情況穩定 下出院。我們知道這個疾病在全世界實屬少見,並希望能以此病例提醒 亞熱帶地區的醫師能對此疾病能有更多的認識,以期能早期診斷並適當 治療。 |
英文摘要 | Pyomyositis and deep neck infection caused by Klebsiella pneumoniae in non-diabetics are rare in Taiwan. Streptoccus spp. and Klebsiella pneumoniae are the leading pathogens for community-acquired brain abscess while liver abscess is the most likely source of K. pneumoniae brain abscess. A case of 59-year-old man with chronic hepatitis C without diabetes mellitus suffered from fever, painful swelling with erythematous change of his right lower leg and right submandibular region for one week. Pyomyositis and deep neck infection were diagnosed according to the computed tomography (CT) of the right lower leg and neck. Blood, wound and pus cultures all yielded growth of K. pneumoniae. Fasciotomy with debridement on his right lower leg and local incision and drainage were performed. The finding of abdominal ultrasound was consistent with liver cirrhosis but no liver abscess was noted. Cefotaxime was administered intravenously every eight hours. Multiple brain abscesses were found incidentally as we followed neck CT on the10th hospital day. A Neurosurgeon was consulted for stereotactic aspiration, and culture of aspirated abscess yielded no growth of bacteria, fungus or mycobacterium. We increased the frequency of cefotaxime from every eight hours to every six hours a day to expedite better penetration into the central nervous system. Brain CT was followed and the size of abscess obviously reduced after a complete courses of antimicrobial therapy. Ultimately, the patient was discharged with the improved physical condition and has since been followed up at our outpatient department. |
本系統中英文摘要資訊取自各篇刊載內容。