米氏克雷伯菌合并白色念珠菌感染致不明原因发热一例并文献复习

doi:10.3877/cma.j.issn.1674-1358.2022.01.010

中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 65 -70. doi: 10.3877/cma.j.issn.1674-1358.2022.01.010

病例报告

米氏克雷伯菌合并白色念珠菌感染致不明原因发热一例并文献复习

刘铭¹, 闻赛², 李娜¹, 陈潇¹, 时玉雯¹, 王刚², 刘岚铮¹, 刘辉¹^,^†(

)

^1. 250021　济南市，济南市疾病预防控制中心细菌性疾病检验所
^2. 250012　济南市，山东大学齐鲁医学院，齐鲁医院感染病科

收稿日期:2021-03-27 出版日期:2022-02-15
通信作者: 刘辉
基金资助:
济南市卫生健康委员会科技计划(No. 2020-4-113)

Report and literature review of a case with fever of unknown origin caused by Klebsiella michiganensis complicated with Candida Albicans infection

Ming Liu¹, Sai Wen², Na Li¹, Xiao Chen¹, Yuwen Shi¹, Gang Wang², Lanzheng Liu¹, Hui Liu¹^,^†()

^1. Institute of Bacterial Disease Detection, Jinan Center for Disease Control and Prevention, Jinan 250021, China
^2. Department of Infectious Diseases, Qilu Medical College of Shandong University, Qilu Hospital, Jinan 250012, China

Received:2021-03-27 Published:2022-02-15
Corresponding author: Hui Liu

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目的

探讨联合应用宏基因组学和培养组学技术对米氏克雷伯菌合并白色念珠菌感染所致不明原因发热患者的病原检测、分离和治疗措施。

方法

分析济南市疾病预防控制中心联合山东大学齐鲁医院对2019年7月1日收治的1例米氏克雷伯菌合并白色念珠菌感染导致的不明原因发热患者的诊疗过程，并复习相关文献。

结果

该患者主动脉层术后持续间断发热，经抗真菌治疗后效果不佳，经宏基因组学测序联合培养组学技术分离病原提示疑似米氏克雷伯菌合并白色念珠菌感染，调整使用头孢哌酮钠舒巴坦钠联合卡泊芬净抗感染治疗后，患者发热症状消失，实验室指标恢复正常后出院。

结论

米氏克雷伯菌感染较少见，且易误诊为其他克雷伯菌，应用宏基因组学联合培养组学技术可尽早明确该病原所致感染，以进行针对性的抗感染治疗。

关键词: 米氏克雷伯菌, 白色念珠菌, 不明原因发热, 宏基因组学测序, 培养组学

Objective

To investigate the detection, isolation and treatment of a case with fever of unknown origin (FUO) caused by Klebsiella michiganensis and Candida Albicans infection by metagenomics and culturomics techniques.

Methods

The diagnosis and treatment process of a FUO patient with Klebsiella michiganensis and Candida Albicans infection admitted by Jinan Center for Disease Control and Prevention and Qilu Hospital of Shandong University on July 1st, 2019 was analyzed, and related literatures were reviewed.

Results

The patient had a FUO after the operation of aortic continuous, but the effect was not well after antifungal treatment. Metagenomics sequencing and culturomics techniques showed that the patient was infected with Klebsiella michiganensis and Candida Albicans. After timely administration of sulperazon and caspofungin for anti-infection, the fever symptoms disappeared and laboratory indexes of the patient restored.

Conclusions

Klebsiella michiganensis infection is relatively rare and easy to be misdiagnosed, metagenomics sequencing and culturomics techniques can be used to identify infection caused by Klebsiella michiganensis as soon as possible, and to carry out effective anti-infection treatment.

Key words: Klebsiella michiganensis, Candida Albicans, Fever of unknown origin, Metagenomic sequencing, Culturomics

图1 宏基因组学测序病原鉴定注：A：米氏克雷伯菌；B：白色念珠菌

图2 GBDP树状图

图3 M21-5和M31-3在MAC平板上的菌落形态及API 20E试验注：A：M21-5在MAC平板上36 ℃培养24 h的菌落形态；B：M31-3在MAC平板上36 ℃培养24 h的菌落形态；C：M21-5的API 20E试验；D：M31-3的API 20E试验

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