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目的分析艾滋病合并沙门菌败血症的临床特点,为该病的诊治提供依据。方法回顾性分析杭州市西溪医院收治的6例艾滋病合并沙门菌败血症患者临床症状、血象、炎症指标、细菌分型、治疗用药及疗效。结果6例患者中社区获得性败血症5例,医院感染1例。发热等全身症状较重,消化道症状不明显。仅1例白细胞增高,为11.38×109/L;嗜酸性粒细胞均减少,其中3例计数为0。C反应蛋白为10~149 mg/L,轻至中度升高;降钙素原基本正常。CD4~+T淋巴细胞计数均<200个/μL,其中4例<50个/μL。5例4个血培养瓶均为阳性,分别为都柏林沙门菌2例,丙型副伤寒沙门菌2例,乙型副伤寒沙门菌1例,仅1例1个需氧菌瓶培养出甲型副伤寒沙门菌。6株沙门菌对氟喹诺酮类,三、四代头孢类,碳青霉烯类均敏感。通过抗菌治疗10~14 d,病情均好转。结论艾滋病合并沙门菌败血症患者全身感染症状明显,消化道反应较轻,炎症指标上升不明显,但菌血症明显,对三、四代头孢菌素及氟喹诺酮类、碳青霉烯类抗生素均敏感。
Objective To analyze the clinical features of AIDS complicated with Salmonella sepsis and provide evidence for the diagnosis and treatment of the disease. Methods Retrospective analysis of 6 cases of AIDS patients with Salmonella septicemia treated by Xixi Hospital in Hangzhou City clinical symptoms, blood, inflammation indicators, bacterial typing, treatment and efficacy. Results Among the 6 patients, 5 were community-acquired sepsis and 1 was hospital infection. Severe systemic symptoms such as fever, gastrointestinal symptoms are not obvious. Only one case of leukocytopenia, 11.38 × 109 / L; eosinophils were reduced, of which 3 cases counted as zero. C-reactive protein 10 ~ 149 mg / L, mild to moderate increase; procalcitonin was normal. CD4 ~ + T lymphocyte count <200 / μL, of which 4 cases <50 / μL. 5 cases of 4 blood culture bottles were positive, respectively, 2 cases of Salmonella Dublin, Salmonella paratyphi 2 cases, Salmonella paratyphi 1 case, only 1 case of an aerobic flask cultured A Paratyphoid Salmonella. Six strains of Salmonella were sensitive to fluoroquinolones, third and fourth generations of cephalosporins and carbapenems. Through antibacterial treatment of 10 ~ 14 d, the condition was improved. Conclusion The symptoms of systemic infection in patients with AIDS and Salmonella sepsis are obvious, the gastrointestinal reaction is mild, the inflammation index is not obvious, but the bacteremia is obvious. The third and fourth generation cephalosporins, fluoroquinolones and carbapenem antibiotics sensitive.