2型糖尿病反复合并类鼻疽伯克霍尔德杆菌脾脓肿一例报告

来自：中国糖尿病杂志编辑：王斐全会标陈道雄等|点击数：|2016-03-03

【提要】 报告1例T2DM渔民因发热先后2次入院，第1次入院血培养和影像学检查提示，类鼻疽伯克霍尔德杆菌败血症和肝脾内多发脓肿，予胰岛素强化控制血糖，予亚胺培南西司他丁联合复方磺胺甲恶唑（SMZ）抗感染1周后体温正常，24 d后改为SMZ单药治疗，74 d后停抗生素和降糖药物；8个月后再次发热，血培养阴性，CT示脾内脓肿。在胰岛素强化控制血糖同时，予头孢他啶联合SMZ抗感染，17 d后改为SMZ单药抗感染，继续胰岛素控制血糖，6个月后停药，复查脾内脓肿体积缩小。血糖的良好控制和感染的积极控制是治疗的关键，在血糖控制不佳和机体免疫力低下时，脾内细菌可复燃。

【关键词】糖尿病，2型；类鼻疽伯克霍尔德杆菌；脾脓肿

One case report of repeated splenic abscess caused by burkholderia pseudomallei in Type 2 diabetes mellitus

【Summary】 A fisherman with type 2 diabetes has admitted to hospital twice due to fever. During the first hospitalization, blood culture and imaging examination showed the presence of burkholderia pseudomallei septicemia and multiple abscesses in liver and spleen. The patient was treated with intensive insulin therapy for glycemic control and imipenem incilastat in combination comepound with sulfamethoxazole(SMZ) for anti-infection. His body temperature returned to normal after one week. The anti-infection regimen was adjusted to SMZ monotherapy after 24 days; antibiotics and hypoglycemic agent were stopped after 74 days. However, the patient hospitalized due to fever again after 8 months. During the second hospitalization, the blood culture was negative and CT showed abscess in spleen. The patient was given insulin for intensive glycemic control and in combination with SMZ for anti-infection. 17 days later, only SMZ was continued for anti-infection, insulin was also continued for glycemic control. All drugs were discontinued after 6 months. The patient was re-examined with splenic abscess reduced. Good glycemic control and active infection control were the keys for treatment. The bacteria in spleen can recrudesce when the patient is in poor glycemic control and low immunity status.ceftazidime

【Key words】 Diabetes mellitus, type 2; Burkholderia pseudomallei; Splenic abscess

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2型糖尿病反复合并类鼻疽伯克霍尔德杆菌脾脓肿一例报告

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