病例报告:糖尿病患者患有甲素敏感黄金葡萄球菌的急性心膜炎
Daniel J Lim1, Richard Lu1, Edwin C Y Sng2
1Department of Cardiology, Changi General Hospital, Singapore, Singapore.
Frontiers in cardiovascular medicine
|December 1, 2025
概括
细菌性心膜炎很少见,但严重. 这一案例突出了糖尿病患者的甲素敏感黄金球菌心膜炎,强调了诊断挑战和成功的手术干预.
科学领域:
- 传染性疾病 传染性疾病
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
背景情况:
- 细菌性心膜炎虽然在抗生素时代很少见,但具有很高的死亡风险.
- 患有未经控制的糖尿病 (DM) 和先前结核病 (TB) 的患者的风险增加.
- 对甲素敏感的金黄色葡萄球菌 (MSSA) 是一种不常见但严重的细菌性心膜炎的原因.
研究的目的:
- 报告一个不寻常的MSSA心膜炎病例,带有透性多溢液.
- 为了说明DM和前结核病的复杂患者的诊断和治疗挑战.
- 强调在患有心周炎的免疫功能低下患者中考虑细菌病因的重要性.
主要方法:
- 一个47岁的女性病例报告,有DM和结核病史,胸部紧张,发烧和呼吸不良.
- 诊断工作包括心电图,炎症标志物,成像和肺部液体分析.
- 聚合酶连锁反应 (PCR) 测试胸腔液的S. aureus和随后的心周窗和活检.
主要成果:
- 患者出现了暗示心周炎的症状和中度至大度的心周溢出.
- 周心造是不可能的;然而,S. aureus通过PCR在多叶液中检测到.
- 手术心周窗口和活检证实MSSA心周炎,导致成功的排水和6周的静脉注射塞法林.
结论:
- 细菌心膜炎,包括MSSA,应考虑在免疫功能低下的患者,特别是那些患有DM或以前结核病的患者.
- 多式成像,分子诊断和早期手术咨询对于当心周细胞切割不可能时至关重要.
- 侵入性诊断策略和多学科合作对于复杂心周感染的最佳管理和结果至关重要.
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