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患者女,30岁,粤西农民。因右上腹疼痛10天,加重4天,伴寒战、高热及尿黄1周入院。体检:T40.8℃,P110次 R24次 BP16.8/10.4KPa。皮肤巩膜中度黄染,心肺无异常,肝右肋下3.0cm、质软、边钝,右上腹压痛无反跳痛,Murphy Sign(+)。实验室检查WBC18.4×10~9/L,N88％,L10％,E2％。GPT96u(正常25u以下),血清胆红素5mg/dl。B超提示胆囊蛔虫,胆管扩张,胆管炎症改变,肝肿大。血培养出细菌,菌体染色形态为G~-,两端钝园,单个排列,周身鞭毛,无芽胞,无荚膜,非抗酸性。培养特征在血平板上24小时长出约2mm边缘整齐,湿润、光滑、稍隆起的菌落,周围有溶血环。生化特
Female patient, 30 years old, farmers in western Guangdong. Right upper quadrant pain for 10 days, aggravating 4 days, accompanied by chills, fever and urinary yellow 1 week admission. Physical examination: T40.8 ℃, P110 times R24 times BP16.8 / 10.4KPa. Skin sclera moderate yellow dye, no abnormal heart and lung, liver right rib 3.0cm, soft, blunt, right upper quadrant tenderness without rebound tenderness. Laboratory tests WBC18.4 × 10 ~ 9 / L, N88%, L10%, E2%. GPT96u (25u below normal), serum bilirubin 5mg / dl. B-Tip gallbladder roundworm, bile duct dilatation, biliary inflammation, hepatomegaly. Bacteria were cultured in blood, and the morphology of the cells was G ~ -, blunt park at both ends, single arrangement, whole body flagella, no bud, no capsule, non-acid resistance. Incubation characteristics On the blood plate 24 hours out grow about 2mm edge neat, moist, smooth, slightly elevated colonies around the hemolysis ring. Biochemical special