糖尿病患者索氏梭菌感染致中毒性休克综合征一例

doi:10.3877/cma.j.issn.1674-1358.2022.05.011

目的

探讨以中毒性休克综合征（TSS）为主要临床表现的糖尿病患者索氏梭菌感染诊治方法。

方法

分析1例以TSS为主要临床表现的糖尿病患者，血液培养样本应用基质辅助激光解吸飞行时间质谱（MALDI-TOF MS）快速鉴定后经基因组比对进一步确认为索氏梭菌，通过基因组学分析其引起的中毒性休克综合征和凝血障碍的致病基因。

结果

该患者有糖尿病病史4年，临床表现为中毒性休克综合征，白细胞总数和中性粒细胞数显著增高。厌氧血培养3 d报阳，厌氧环境下转种后形成扁平不规则菌落，MALDI-TOF MS联合16S rDNA序列检测确诊为索氏梭菌。通过基因组学分析索氏梭菌含有溶血素、磷脂酶C和神经氨酸酶基因，上述基因编码的产物可导致炎症和溶血反应。给予患者综合抗感染对症处理后疗效欠佳，病情恶化迅速，在确诊后半个月内死亡。

结论

MALDI-TOF MS快速鉴定和基因组学分析对索氏梭菌引起感染的诊断和治疗具有重要意义。厌氧菌分离培养后通过MALDI-TOF MS快速鉴定结合生物信息学分析为索氏梭菌诊治的关键。

关键词: 索氏梭菌, 中毒性休克综合征, 基质辅助激光解吸飞行时间质谱, 基因组学分析, 凝血功能障碍

Objective

To investigate the diagnosis and treatment of Paeniclostridium sordellii (P. sordellii) infection in diabetes patients with toxic shock syndrome (TSS).

Methods

A patient with TSS as the primary clinical manifestation was detailed, and the blood culture was confirmed as P. sordellii by genomic alignment after being identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Toxic shock syndrome and coagulation disorder caused by P. sordellii were analyzed based on genomics analysis.

Results

The patient had a 4-year history of diabetes and presented clinically with toxic shock syndrome with a significantly elevated total leukocyte count and neutrophil count. The anaerobic blood culture was reported positive for three days. The microorganism formed irregular colonies after temporary seeding in an anaerobic environment, and MALDI-TOF MS combined with 16S rDNA sequence detection confirmed the diagnosis of P. sordellii. Genomic analysis of P. sordellii contains hemolysin, phospholipase C and neuraminidase genes, and the products encoded by the genes can lead to inflammatory and hemolytic responses. The treatment was ineffective after the administration of comprehensive anti-infective symptomatic treatment, and the disease deteriorated rapidly and the patient died within half a month after diagnosis.

Conclusions

Rapid identification by MALDI-TOF MS and genomic analysis are essential for diagnosing and treating infection caused by P. sordellii. Rapid identification of P. sordellii infection by mass spectrometry after isolation and culture of anaerobic bacteria combined with bioinformatics analysis is critical to diagnosing and treating P. sordellii infection.

Key words: Paeniclostridium sordellii, Toxic shock syndrome, matrix-assisted laser desorption ionization time-of-flight mass spectrometry, Genomic analysis, Coagulation disorder

图1 患者血培养结果（革兰染色，1 000 ×）

图2 患者血培养48 h菌落

图3 患者腹部与下肢静脉超声注：A：腹部超声；B：下肢静脉超声

图4 患者血栓弹力图

图5 患者入院后血小板和D-二聚体监测的曲线图

图6 P. sordellii AM370全基因组序列环状图注：内圈为P. sordellii AM370菌株全基因组序列环状图以及外圈为溶血素、磷脂酶C、神经氨酸酶基因编码序列位点；中间圈层为G-C含量示意图

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A diabetic case with toxic shock syndrome caused by Paeniclostridium sordellii infection

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A diabetic case with toxic shock syndrome caused by Paeniclostridium sordellii infection