{"title":"卡介苗(BCG)播散性感染,表现为严重呼吸衰竭和脓毒性休克。","authors":"Diamantina Marouli, Charalampos Pappas, Maria Raissaki, Athanasia Proklou, Eleftherios Papadakis, Eumorfia Kondili","doi":"10.18683/germs.2023.1395","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur.</p><p><strong>Case report: </strong>We report the unusual case of a man in his mid '70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to <i>Mycobacterium bovis</i> dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection.</p><p><strong>Conclusions: </strong>Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.</p>","PeriodicalId":45107,"journal":{"name":"GERMS","volume":null,"pages":null},"PeriodicalIF":1.7000,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748841/pdf/","citationCount":"0","resultStr":"{\"title\":\"Disseminated Bacillus Calmette-Guérin (BCG) infection presenting as severe respiratory failure and septic shock.\",\"authors\":\"Diamantina Marouli, Charalampos Pappas, Maria Raissaki, Athanasia Proklou, Eleftherios Papadakis, Eumorfia Kondili\",\"doi\":\"10.18683/germs.2023.1395\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur.</p><p><strong>Case report: </strong>We report the unusual case of a man in his mid '70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to <i>Mycobacterium bovis</i> dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection.</p><p><strong>Conclusions: </strong>Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.</p>\",\"PeriodicalId\":45107,\"journal\":{\"name\":\"GERMS\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2023-09-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10748841/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"GERMS\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.18683/germs.2023.1395\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"GERMS","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.18683/germs.2023.1395","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/9/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
简介膀胱内注射卡介苗(BCG)是治疗浅表性膀胱癌最有效的辅助疗法,可延长无病生存期。虽然该疗法通常耐受性良好,但也可能出现中度至重度局部或全身感染性并发症,包括累及多个器官的败血症:我们报告了一例不寻常的病例:一名 70 多岁的男子出现脓毒性休克和严重急性呼吸衰竭,需要插管治疗。由于对抗生素无反应、膀胱内卡介苗灌注史和影像学检查结果一致,患者接受了进一步检查,支气管肺泡灌洗液(BAL)聚合酶链反应(PCR)结果显示患者患有牛分枝杆菌播散引起的肺炎。及时的抗结核治疗和皮质类固醇治疗使患者的临床和影像学症状明显好转,支持了卡介苗播散感染的诊断:结论:由于卡介苗感染的临床表现无特异性,且传统微生物检验的诊断率相对较低,因此需要高度怀疑才能及时诊断和治疗全身性卡介苗感染。基于 PCR 技术的分枝杆菌 DNA 鉴定方法可能是一种宝贵的工具,有助于及时诊断这种不常见但可能危及生命的感染。
Disseminated Bacillus Calmette-Guérin (BCG) infection presenting as severe respiratory failure and septic shock.
Introduction: Intravesical Bacillus Calmette-Guérin (BCG) instillation is the most effective adjuvant therapy for superficial urinary bladder carcinoma, prolonging disease-free survival. Although it is usually well tolerated, moderate to severe local or systemic infectious complications, including sepsis involving multiple organs, may occur.
Case report: We report the unusual case of a man in his mid '70s who presented with septic shock and severe acute respiratory failure requiring intubation. Lack of response to antibiotics, history of intravesical BCG instillation and consistent imaging findings led to further investigations, with bronchoalveolar lavage (BAL) fluid polymerase chain reaction (PCR) results indicating pneumonitis due to Mycobacterium bovis dissemination. Prompt anti-tuberculosis treatment combined with corticosteroids resulted in significant clinical and radiological improvement, supporting the diagnosis of disseminated BCG infection.
Conclusions: Due to its non-specific clinical presentation and the relatively low diagnostic yield of conventional microbiological tests, a high index of suspicion is required for prompt diagnosis and treatment of systemic BCG infection. PCR-based assays for mycobacterial DNA identification may represent a valuable tool facilitating timely diagnosis of this uncommon, yet potentially life-threatening infection.