| Objective:To investigate the clinical features of patients with Burkholderia pseudomallei septicemia in Guangxi province for reviewing our experience and helping to improve the strategy of diagnosis and therapy.Method:The clinical features,imaging features,treatment and prognosis of 4 cases with acute septicemic melioidosis,who were admitted to the first affiliated hospital of Guangxi medical university from October 2006 to December 2008,were retrospectively analyzed.Results:(1)4 patients were men,local farmers,their average age was 41.75±1.76 years old,two of them had a history of frequent trauma and contact with polluted water,others had a history of exposure to the dust and soil.(2)All patients had acute onset,manifested as septicemia with chills,high-grade fever,anemia,weight loss and other symptoms.At the same time they were often complicated with multiple organs' abscesses.One case was of the lung abscess with right calf skin pyogenic infection,and the another case was with liver,spleen,pancreas and mediastinum abscess,and the third one was suffering from the right facial and ankle soft tissue abscess.(3)Laboratory results①The leukocyte counts[(11.62±0.49)×10~9/L]and neutrophile granulocytes [(8.31±0.40)×10~9/L]in 3 patients were slightly increased,but decreased for the another patient.②There were significant increase of erythrocyte sedimentation rate(63.5±2.69) mm / h and c-reactive protein(154.5±3.96) mg/L in 4 patients with melioidosis,and liver dysfunction and elevated blood glocuse happened to 3 of 4 patients,but without a history of diabetes.(4) imaging features:there were a number of patchy or infiltrationa,fusion,and nodules with varying sizes in the upper lobes of lung.Abscesse out of the lungs mainly happened to liver,spleen,skin and other parts of patients with melioidosis.(5) The final diagnosis confirmed as Burkholderia pseudomallei depended on repeated blood or liquor puris culture.(6) 4 patients were all misdiagnosed as pneumonia,pulmonary tuberculosis or septicemia when they saw doctors for the first time.(7) Burkholderia Pseudonmall was sensitive to carbapenem,β-lactam orβ-lactam+β-lactamase inhibitor.One patient must be treated effectively with Imipenem,and other 3 patients withβ-lactam orβ-lactam+β-lactamase inhibitor.After 3 or 4 days of treatment with antibiotics,the body temperature of these patients gradually decreased,and the intravenous drug was used as long as 4 to 8 weeks,and a total course of antibiotic therapy would continue for 4 to 6 months.Conclusions:(1)Human melioidosis exists in the south and southwest of Guangxi,occured at the rainy and windy season(7 to 11 months).Patients with melioidosis mostly are young to middle-aged men,farmers,with a history of frequent skin damage and exposure to polluted water or dust and soil.(2) Patients had acute onset,with the main symptoms of chills and high fever,and multiple organ abscesses(lung,liver,spleen,skin,and etc.),and also multiple organ dysfution,especially for the lung,so that patients were easily be misdiagnosed as tuberculosis and other diseases.There were slight increase of leukocyte and neutrophile granulocytes,but significant decrease of hemoglobin in patients with melioidosis.In addition,most patients were suffering from difficult control of high blood glucose.Pathogen of melioidosis would found by repeated blood or liquor puris culture.(3) Burkholderia Pseudonmall was sensitive to carbapenem,β-lactam orβ-lactam+β-lactamase inhibitor.One patient must be treated effectively with Imipenem,and other 3 patients withβ-lactam orβ-lactam+β-lactamase inhibitor(ceftazidime or Cefoperazone +Sulbactam).After 3 or 4 days of treatment with antibiotics,the body temperature of these patients gradually decreased,and the abscess were gradually absorbed after 4 to 8 weeks of intravenous antibiotics use,the total course of treatment was of 4 to 6 months.(4)Early abscess drainage treatment and control of blood glucose were one of the keystones of successful treatment. |
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