咽后Eggerthia catenaformis感染引起的下行性坏死性纵隔炎。

IF 1.7 Q3 INFECTIOUS DISEASES GERMS Pub Date : 2023-09-30 eCollection Date: 2023-09-01 DOI:10.18683/germs.2023.1394
Alessandro Graziani, Maria Vittoria Tamburini, Francesco Congestrì, Ludovico Graziani, Maria Giulia Sama, Guido Caroli, Riccardo Spaggiari
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引用次数: 0

摘要

导言:卡氏埃格氏菌(Eggerthia catenaformis)是人类粪便微生物群中的一种非芽孢厌氧革兰阳性杆菌,很少有报道称它会引发人类疾病。在迄今为止的文献中描述的几乎所有病例中,牙科疾病(脓肿、牙周炎或龋齿)都是最常见的感染源,感染范围扩展到大脑、颈椎间隙、肺实质、胸膜腔、腹壁和腹腔:一名 82 岁的白种男性患者因右侧下颌下无痛性肿块、呼吸困难和吸气性哮鸣音而被送入本院急诊科(ED)。使用静脉注射造影剂对患者的头部、颈部和胸部进行 CT 扫描后发现,患者的颌后有积液。从右侧下颌下区域到脊柱、胸主动脉降支和气管之间的下纵隔存在气泡和少量积液。患者接受了手术治疗和广谱抗生素治疗。咽后积液培养显示存在卡氏埃格氏菌。在重症监护室住了一段时间后,他被送进了降级病房(SDU),在那里他接受了呼吸道断奶、运动康复治疗,并逐渐恢复了口服喂食。出院时,由于患者吞咽固体食物的能力仍有障碍,因此仍保留了气管插管:在此,我们报告了首例在没有牙科疾病的情况下,咽后脓肿患者发生降解性坏死性纵隔炎的病例。
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Descending necrotizing mediastinitis caused by retro-pharyngeal Eggerthia catenaformis infection.

Introduction: Eggerthia catenaformis, a non-spore-forming anaerobic Gram-positive bacillus component of the human fecal microbiota has rarely been reported in human diseases. In almost every case described in current literature to date, dental diseases (abscesses, periodontitis, or caries), are the most common source of the infection which extends to the brain, cervical spaces, pulmonary parenchyma, the pleural cavity, the abdominal wall, and the abdominal cavity.

Case report: An 82-year-old male Caucasian patient was admitted to our Emergency Department (ED) with a painless, right submandibular mass, dyspnea, and inspiratory stridor. A CT scan of the head, neck, and chest with intravenous contrast material revealed a retrotonsillar fluid collection. Air bubbles and minimal fluid were present from the right sub-mandibular area to the lower mediastinum between the spine, the descending thoracic aorta, and the trachea. The patient underwent surgical treatment and a broad-spectrum antibiotic. The retropharyngeal fluid collection culture showed the presence of Eggerthia catenaformis. After a first period in the Intensive Care Unit, he was admitted to a Step-Down Unit (SDU) where he underwent respiratory weaning, motor rehabilitation, and gradual oral feeding resumption. At discharge, the patient maintained the tracheal cannula as he still had impaired swallowing of solid foods.

Conclusions: Here we report the first case of descending necrotizing mediastinitis in a patient with a retropharyngeal abscess, in the absence of dental diseases.

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来源期刊
GERMS
GERMS INFECTIOUS DISEASES-
CiteScore
2.80
自引率
5.00%
发文量
36
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