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2014, vol. 71, br. 3, str. 317-324
Diseminovana Rhodococcus equi infekcija kod bolesnice sa Hočkinovim limfomom
aVojnomedicinska akademija, Klinika za infektivne i tropske bolesti, Beograd + Univerzitet odbrane, Medicinski fakultet Vojnomedicinske akademije, Beograd
bVojnomedicinska akademija, Institut za radiologiju, Beograd
cVojnomedicinska akademija, Klinika za infektivne i tropske bolesti, Beograd
dVojnomedicinska akademija, Institut za mikrobiologiju, Beograd
Sažetak
Uvod. Rhodococcus (R) equi je oportuni patogen koji retko uzrokuje oboljenje u humanoj populaciji, uglavnom kod imunokompromitovanih domaćina. Oboljenje se obično ispoljava kao subakutna pneumonija koja je često kavitarna i neretko praćena bakterijemijom. Prikaz bolesnika. Prikazujemo veoma redak slučaj bolesnice stare 43 godina sa Hočkinovim limfomom, kod koje je došlo do razvoja R. equi pneumonije u toku primene hemoterapije. Kasnije, kod bolesnice je došlo do razvoja bakterijemije i sepse uz diseminaciju R. equi infekcije u brojna ekstrapulmonalna tkiva. Na prijemu bolesnica je bila febrilna, tahipnoična, tahikardična, hipotenzivna, sa otokom lica, splenomegalijom, pozitivnim meningealnim znacima, levostranom hemiparezom i paraparezom. U laboratorijskim nalazima sedimentacija eritrocita (SE) bila je > 140 mm/h, C-reaktivni protein (CRP) 143,0 mg/L, eritrociti 2,14 × 109/L, leukociti 2,8 × 1012/L, lektat dehidrogenaza (LDH) 706 U/L, serumski albumin 26 g/L, natrijum 127 mmol/L i kalijum 2,7 mmol/L. Hemokulturom i kulturom sputuma i empijema izolovan je R. equi. Radiološke metode registrovale su veliku kavitarnu pneumoniju i apsces pluća, empijem pleure, perikarditis, medijastinalnu i abdominalnu limfadenopatiju, apsces mozga i psoasa, osteomijelitis i spondilodiscitis. Bolesnica se potpuno oporavila nakon 12 meseci terapije kombinacijama parenteralnih i peroralnih antibiotika, uz primenu drenaže apscesnih kolekcija i empijema. Osam godina po završenoj terapiji kod bolesnice nije zabeležen recidiv R. equi infekcije niti limfoma. Zaključak. S obzirom na to da je eradikacija R. equi veoma teška, od velike je važnosti što ranije postaviti dijagnozu i otpočeti adekvatnu antibiotsku terapiju.
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O članku

jezik rada: engleski
vrsta rada: prikaz slučaja
DOI: 10.2298/VSP121218035M
objavljen u SCIndeksu: 20.03.2014.
metod recenzije: dvostruko anoniman

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