投稿分類 微生物

主委發表種類: 壁報

投稿標題(中): 一位糖尿病人之社區性肺炎同時混合感染A型流感、肺炎鏈球菌、退伍軍人菌與侵襲性肺部麴病

投稿標題(英): Concurrent Infections of Influenza A, Streptococcus pneumoniae, Legionella and Invasive Pulmonary Aspergillosis in a Diabetic Patient with Community-acquired Pneumonia

投稿摘要: A 63 y/o diabetic man was admitted to the intensive care unit of the hospital on June 20, 2015 due to pneumonia with septic shock. A blood pressure of 80/60 mmHg was noticed. White cell count was 15,700/uL; band, 18.0%; CRP, 91.9 mg/L and procalcitonin, 11.94 ng/ml. CXR showed left perihilar infiltration. Piperacillin- tazobactam was used. The sputum culture yielded oxacillin-resistant Staphylococcus aureus. Moxifloxacin was added to cover atypical pneumonia. However, the lung infiltration was worsening. PCR-FluA for nasopharynx swab was positive. The urine Pneumococcus rapid antigen and Legionella antigen tests were both positive. The blood Aspergillus antigen index was 4.89 (positive). As refractory hypotension, antimicrobials were shift to oseltamivir, imipenem, tigecycline and voriconazole. Unfortunately, right-sided tension pneumothorax with mediastinum shifted to left side happened on July 3. Chest tube was inserted to relieve the pneumothorax. Sputum culture yielded cabapenem-resistant Acinetobacter baumannii. Antimicrobials were adjusted to ceftazidime, levofloxacin and voriconazole. He remained unstable hemodynamics and poor oxygenation status. CXR showed subcutaneous emphysema of bilateral neck and chest wall with diffuse lung infiltrates. The patient passed away on July 19, 2015. In conclusion, we conducted a detailed survey for pneumonia pathogens in severe influenza infection, such as pneumococcus, Legionella and aspergillosis. Early diagnosis and treatment may be helpful.

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