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目的分析1例药物性肝损伤/慢性重度乙型肝炎患者伴发血行播散型霍乱感染的影响因素。方法收集患者病历和流行病学资料,采集血液、肛拭子等样本开展血清分型、毒力基因及药物敏感性检测。结果该病例患有慢性乙肝40多年,2015年11月16日至南昌大学第一附属医院就诊,入院诊断为药物性肝损伤、慢性重度乙型病毒性肝炎、肺结核和2型糖尿病。自住院以来一直有腹泻症状,排除肠结核。11月18日,患者大便涂片镜检革兰染色阳性菌(+),革兰染色阴性菌(+++),并出现发热症状;24日血涂片革兰染色阳性菌(++);25日患者血液中分离到霍乱弧菌,血平板上出现带绿色金属光泽的β溶血菌落,经血清分型、毒力基因及药物敏感性检测,判定为不产霍乱毒素的O139霍乱弧菌。流行病学调查显示11月10日该患者家中曾自行购买甲鱼食用,除患者外其他共同就餐者均未出现腹泻症状。结论病例发病可能与食用甲鱼有关,霍乱弧菌血行播散可能与该菌株带有霍乱溶血素和患者凝血功能障碍有关。
Objective To analyze the influencing factors of cholera infection in a patient with drug-induced liver injury or chronic severe hepatitis B who has hematogenous spread. Methods Patient records and epidemiological data were collected, and blood samples, anal swabs and other samples were collected for serotyping, virulence genes and drug susceptibility testing. Results The patient had chronic hepatitis B for more than 40 years. He was admitted to the First Affiliated Hospital of Nanchang University on November 16, 2015 and was diagnosed with drug-induced liver injury, chronic severe hepatitis B, tuberculosis and type 2 diabetes. There have been diarrhea symptoms since hospitalization, excluding intestinal tuberculosis. On November 18, patients stool smear Gram-positive bacteria (+), Gram-negative bacteria (+++), and fever symptoms; 24 smear Gram-positive bacteria (++) ; Vibrio cholerae was isolated from the blood of 25 patients on the blood plate, and β-hemolytic colony with green metallic luster appeared on the blood plate. Vibrio cholerae O139 was identified as Vibrio cholerae O139 by serological typing, virulence genes and drug sensitivity test . Epidemiological survey showed that on October 10, the patients at home had purchased the soft-shelled turtle for their own consumption, and no diarrhea symptoms were found in other co-diners except the patients. Conclusions The incidence of the disease may be related to the consumption of soft-shelled turtle. Vibrio cholerae may be related to hemolysis of cholera hemolysin and coagulation dysfunction in this strain.