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2018, vol. 52, br. 3, str. 117-120
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Milijarna tuberkuloza komplikovana stafilokoknom sepsom
Miliary tuberculosis complicated by staphylococcal sepsis
aSpecial Hospital for Nonspecific Lung Diseases 'Sokobanja', Sokobanja bSpecial Hospital for Lung Diseases 'Ozren', Sokobanja cUniverzitet u Kragujevcu, Medicinski fakultet, Katedra za radiologiju, nuklearnu medicinu i onkologiju + Klinički centar Kragujevac, Služba za radiološku dijagnostiku
e-adresa: opancina.valentina@gmail.com
Sažetak
Milijarna tuberkuloza je potencijalno fatalna zbog masivne diseminacije Mycobacterium tuberculosis. Pošto su imunoregulatorni mehanizmi poremećeni, tokom evolucije milijarne tuberkuloze razvijaju se nespecifične infekcije, a ponekad čak i sepsa. Sepsa je retka komplikacija kod imunokompetentnog pacijenta. Kod pacijenata s diseminovanom tuberkulozom treba obratiti pažnju i sprovesti posebnu negu ako klinička prezentacija ukazuje na sepsu. U ovom radu predstavljamo pacijenta kod koga smo u isto vreme dokazali postojanje milijarne tuberkuloze i stafilokokne sepse na prijemu 2007. godine. Prvo smo dijagnostikovali milijarnu tuberkulozu histopatološki putem transbronhijalne biopsije, a nakon toga potvrdili mikrobiološkim i oftalmološkim pregledom. Dva krvna uzorka za hemokulturu sa različitih lokacija punkcija izolovale su Staphylococcus epidermidis. Odmah nakon prijema, medicinski tim je započeo lečenje septičkog šoka i respiratorne insuficijencije primenom oksigenoterapije, parenteralne rehidracije, vazoaktivnih agensa uz odabranu kombinaciju antibiotika i antituberkulotika. Tretman se nastavio u ekstenzivnoj fazi korišćenjem kombinacije antituberkulotika i pacijent je otpušten da se leči kod kuće i dolazi na kontrole u antituberkuloznu ambulantu.
Abstract
Milliary tuberculosis is potentially fatal due to the massive dissemination of Mycobacterium tuberculosis. Since immunoregulatory mechanisms are disrupted, during the evolution of milliary tuberculosis, nonspecific infections develop and sometimes even sepsis. Sepsis is a rare complication in immunocompetent patient. In patients with disseminated tuberculosis, close attention and care should be made if clinical presentation suggests sepsis. In this paper, we present a patient with whom we simultaneously diagnosed miliary tuberculosis and staphylococcal sepsis on admission in 2007. Miliary tuberculosis was first proven histopathologically by transbronchial lung biopsy, and later confirmed by microbiological and ophthalmologic examination. Two blood samples from different punction locations had isolated Staphylococcus epidermidis. Right after the admission, medical team started a treatment of septic shock and respiratory failure with the oxygen therapy, parenteral rehydration, vasoactive agents with a combination of selected antibiotics and antituberculotic drugs. After recovery, the treatment was continued in extensive phase using combination of antituberculotics and patient was discharged to be home treated and checked in an antituberculous ambulant.
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