摘要目的 提高对猪霍乱沙门菌感染致脓气胸临床表现、诊断及治疗的认识.方法 报道2010年6月浙江中医药大学附属第一医院收治的1例猪霍乱沙门菌感染致脓气胸病例,并进行相关文献复习.以“猪霍乱沙门菌,脓胸”为检索词通过万方医学数据库对中文文献进行检索,以“Salmonella choleraesuis,thoracic empyema”为检索词通过PubMed检索系统进行检索.检索时间截至2011年5月.结果 患者女,43岁,患糖尿病,因“发热伴右胸痛4d”入院.胸部CT示右侧胸腔内混杂密度影,上至胸腔顶部,下至膈面,团块状高密度影周围与内部可见不规则气体密度影,未见气液平面.血培养、气管镜下吸取的支气管分泌物培养沙门菌阳性.最初静脉给予抗生素(先后给予哌拉西林/他唑巴坦、头孢他啶、亚胺培南-西司他丁)治疗无效.后经开胸手术治疗,右侧脓胸清除,留置胸管闭锁引流.胸腔积液培养猪霍乱沙门菌阳性.术后反复进行右侧胸腔冲洗引流,并给予抗生素等综合治疗,患者好转出院.以“猪霍乱沙门菌,脓胸”为检索词在万方医学数据库检索未见到相关报道.以“Salmonella choleraesuis,thoracic empyema”为检索词在PubMed检索系统检索到3篇文献,2篇为个案报道,1篇为回顾性分析.共报道973例胸腔积液细菌培养阳性病例,其中12例为沙门菌属,男9例,女3例,平均年龄49岁,其中10例合并恶性肿瘤、肝硬化、糖尿病等基础疾病,机体免疫力低下.12例中,7例为猪霍乱沙门菌感染,其中4例死亡.结论 猪霍乱沙门菌感染致脓气胸或脓胸较为罕见,病死率高.多发生于存在基础疾病、机体免疫力低下者.三四代头孢菌素或碳青霉烯类抗生素治疗的同时,尽快行脓胸清除术并冲洗引流,患者预后良好.

abstractsObjective To improve understanding of the clinical features,diagnosis and treatment of pyopneumothorax caused by Salmonella choleraesuis. Methods One case of pyopneumothorax caused by Salnonella choleraesuis diagnosed and treated in our hospital in 2010 was reported and the related literatures were reviewed.As of May 2011,the literature review was carried out with "Salmonella choleraesuis" and "thoracic empyema" as the search terms in Wanfang Med Online and Pubmed Database. Results A 43 year-old Chinese woman presenting with fever and chest pain for 4 days was admitted to our hospital.ACT scan of the chest revealed a massive shadow with mixed density in the right hemithorax,from the top of thorax to diaphragmatic surface,and there was air inside or surrounding the mass irregularly but without an air-fluid level.Blood culture and bronchial secretion culture by bronchoscope both showed some serotypes of Salmonella strains. At first intravenous antibiotic therapy (piperacillin-tazobactam,ceftazidime,and then imipenem-cilastatin) was ineffective.Open chest surgery was performed,and chest tube placed.Salmonella choleraesuis was isolated from the drained pleural fluid.Chest tube drainage remained in place for more than 6 weeks,and with prolonged antibiotic therapy,which contributed to a good outcome. Literature review found no related reports in Wanfang Med Online,while 3 literatures were found in Pubmed,including 2 of case report and 1 of retrospective study. Among 973 patients with empyema thoracis in the retrospective study,12 of these patients,including 9 men and 3 women,were infected with Salmonella species. The median age was 49 years,and 10 patients were immunocompromised,including malignancy,liver cirrhosis,and diabetes mellitus. Seven patients were infected with Salmonella choleraesuis,and 4 (57％) of them died.Conclusions Pyopneumothorax or thoracic empyema is a rare complication of Salmonella choleraesuis infection. Higher rates of death were noted in this disease. Salmonella choleraesuis infection is even more serious in adult patients with underlying diseases. Early diagnosis,appropriate antimicrobial drug therapy,and aggressive drainage are necessary to improve the outcome of patients with pyopneumothorax or thoracic empyema due to Salmonella choleraesuis.