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缺陷乏氧菌感染性心内膜炎合并心、脑、脾脏器梗死1例
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Abstract:
目的：总结1例由缺陷乏氧菌引起的感染性心内膜炎的临床特点及诊疗过程，以提升对该病原体及疾病的认识。方法：回顾性分析2023年9月于济宁医学院附属医院儿童监护室收治的1例缺陷乏氧菌感染性心内膜炎患儿的临床资料，并结合相关文献进行综述。结果：患儿以咳嗽及肢体无力为主要表现，脑部MRI检查显示大面积脑梗死，紧急行经皮脑动脉闭塞开通术，术中出现急性心肌梗死，术后继续抗栓及维持生命体征稳定治疗。随后心脏超声检查发现主动脉瓣赘生物，确诊为感染性心内膜炎，随后血培养结果证实为缺陷乏氧菌感染，经头孢哌酮钠舒巴坦钠联合万古霉素抗感染治疗后病情有所改善。但患儿之后再次出现脾梗死，经抗凝治疗后进一步接受了主动脉瓣机械瓣膜置换术及赘生物清除术，最终病情好转出院。结论：缺陷乏氧菌所致的感染性心内膜炎更易形成瓣膜赘生物并引发多器官栓塞，其预后较差，病死率较高。及时准确的诊断与治疗对改善患者结局至关重要，这强调了早期进行病原体鉴定的必要性。
Objective: To summarize the clinical characteristics and treatment process of a case of infective endocarditis caused by Abiotrophia defectiva, enhancing understanding of this pathogen and disease. Methods: Retrospective analysis of a case of Abiotrophia defectiva-induced infective endocarditis in a child admitted to the Pediatric Intensive Care Unit of Jining Medical University Affiliated Hospital in September 2023, combined with a literature review. Results: The child presented with cough and limb weakness. Brain MRI revealed a large-area cerebral infarction, leading to emergency percutaneous cerebral artery recanalization. Intraoperatively, acute myocardial infarction occurred. Post-operatively, anti-thrombotic and life-support treatments were continued. Bedside echocardiography showed aortic valve vegetation, confirming infective endocarditis. Blood culture identified Abiotrophia defectiva. After treatment with cefoperazone/sulbactam and vancomycin, the condition improved. However, splenic infarction later occurred. Following anticoagulation therapy, the child underwent aortic valve replacement and vegetation debridement, and was eventually discharged in stable condition. Conclusion: In cases of infective endocarditis caused by Abiotrophia defectiva, there is a higher likelihood of valve vegetation formation and multi-organ embolism, resulting in poor prognosis and high mortality. Timely and accurate diagnosis and treatment are crucial. Early pathogen identification is essential for patients with infective endocarditis.
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