类鼻疽心包炎误诊为结核性心包炎1例

A Case of Melioidosis Pericarditis Misdiagnosed as Tuberculous Pericarditis

摘要: 本文报告1例少见的类鼻疽心包炎误诊为结核性心包炎，患者为36岁男性，渔民，因“间断性胸闷、呼吸困难10余天”入院。经血培养、心包积液培养均检出假鼻疽伯克霍尔德菌，确诊为类鼻疽，并经心脏彩超证实大量心包积液。药敏试验显示对亚胺培南、头孢他啶、多西环素、复方磺胺甲恶唑敏感，采取抗感染、控制血糖等内科对症治疗后患者炎症指标基本恢复正常，心包积液基本吸收。由于类鼻疽心包炎和结核性心包炎的临床表现及心包积液生化结果相似，二者不易鉴别。在结核病高负担地区，结核分枝杆菌仍然是心包炎的最常见原因，而在类鼻疽疫区，临床医生和微生物学家应意识到假性伯克霍尔德菌亦是一种罕见的心包炎病因，避免误诊及漏诊。

Abstract: This paper reports a rare case of melioidosis pericarditis misdiagnosed as tuberculous pericarditis. The patient was a 36-year-old male fisherman who was admitted to the hospital because of “inter-mittent chest tightness and dyspnea for more than 10 days”. Burkholderia pseudomelioidis was detected by blood culture and pericardial effusion culture, and the diagnosis of melioidosis was con-firmed by echocardiography. The drug sensitivity test showed that the patients were sensitive to imipenem, ceftazidime, doxycycline and compound sulfamethoxazole. After taking symptomatic medical treatment such as anti-infection and blood glucose control, the inflammatory indicators of the patients basically returned to normal, and the pericardial effusion was basically absorbed. It is difficult to distinguish melioidosis pericarditis from tuberculous pericarditis due to the similar clinical manifestations and biochemical results of pericardial effusion. In areas with a high burden of tuberculosis, MTB remains the most common cause of pericarditis. In melioidosis endemic areas, clinicians and microbiologists should be aware that Burkholderia pseudomonas is also a rare cause of pericarditis to avoid misdiagnosis and missed diagnosis.