假结核棒状杆菌致淋巴结炎1例及文献回顾

Lymphadenitis caused by Corynebacterium pseudotuberculosis: a case report and literature review

  • 摘要: 探讨假结核棒状杆菌(Cp)感染的高危因素、临床表现、诊断及治疗,以期为Cp感染诊疗提供思路。回顾性分析2024年12月7日山东第一医科大学附属省立医院收治的1例Cp致淋巴结炎的病例资料,并检索Cp感染的国内外文献,共纳入符合标准的29例病例材料进行文献回顾。该患者与猫、羊密切接触,左侧腋窝及左肘淋巴结肿大,行病变淋巴结切除术后伤口不愈合,抽取脓液通过病原微生物宏基因组二代测序(mNGS),结合细菌培养明确诊断,随后予以利奈唑胺联合青霉素抗感染治疗,感染症状好转后出院。文献回顾显示,大部分病例无基础疾病但有有蹄动物接触史,主要临床表现为淋巴结肿大,除进行抗感染治疗外需联合手术切除,多数病例诊断时间及疗程均较长。Cp感染临床罕见,可通过接触Cp感染的有蹄动物感染,mNGS有助于早期诊断,手术切除患病淋巴结后,应选取适宜的抗菌药物,足疗程用药,提高抗感染疗效。

     

    Abstract: The high risk factors, clinical manifestations, diagnosis and treatment of Corynebacterium pseudotuberculosis infection were explored so as to provide ideas for diagnosis and treatment of C. pseudotuberculosis infection. The medical data of 1 patient with C. pseudotuberculosis-induced lymphadenitis who was treated in Provincial Hospital Affiliated to Shandong First Medical University on Dec. 7, 2024 was retrospectively analyzed, the literatures regarding the C. pseudotuberculosis infection at home and abroad were searched, and totally 29 cases whose data met the criteria were included, a literature review was carried out. The patient had a close contact history with cats and sheep and presented lymphadenopathy on left axillary and left elbow, and the wound failed to heal after lymph node excision. The pus specimens were extracted for etiological culture through metagenomic next-generation sequencing (mNGS), and a definite diagnosis was made with the combination with bacterial culture. The patient was improved with the symptom of infection and was discharged after treatment with linezolid combined with penicillin. The literature review indicated that most of the involved cases did not have underlying diseases but had the history of contact with ungulates, mainly manifesting as lymphadenopathy, the cases needed additional surgical excision on the bases of antimicrobial therapy, and most of the cases had long diagnosis process and treatment course. C. pseudotuberculosis infection is clinically rare and is usually acquired through contact with infected ungulates. mNGS facilitates the early diagnosis. It is necessary to choose appropriate antibiotics after surgical excision of lymph nodes and carry out full course of drug administration so as to improve the antimicrobial effect.

     

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