海分枝杆菌引起骨髓增生异常综合征患者血流感染一例

田瑞卿 陈爱地 王卫红

【摘要】海分枝杆菌属于光产色缓慢生长型非结核分枝杆菌的一种，该文报告1例由海分枝杆菌引起血流感染的骨髓增生异常综合征患者，其因面色苍白乏力20余年、意识模糊1 d入院。患者于20年前被诊断为再生障碍性贫血，入院前半年被诊断为骨髓增生异常综合征，入院后通过全自动血培养仪对其静脉血标本进行需氧和厌氧培养，分离阳性培养物，经革兰染色及抗酸染色后，再进一步使用质谱分析技术进行鉴定，最后明确为海分枝杆菌感染。积极给予患者抗感染、调节免疫以及其它對症治疗后仍无效，其因呼吸、心力衰竭而死亡。海分枝杆菌为革兰阳性杆菌，抗酸染色阳性，常规方法无法鉴定，因此对于血培养分离到的细菌，除了采用革兰染色及常规方法鉴定外，还需结合抗酸染色以及质谱分析技术，以便为不常见细菌的鉴定提供可靠依据。

【关键词】海分枝杆菌；血流感染；非结核分枝杆菌

【Abstract】Mycobacterium marinum is a type of slow-growing photochromogenic nontuberculous mycobacteria. Here， we reported one case of myelodysplastic syndrome presenting with bloodstream infection induced by Mycobacterium marinum. The patient was admitted to our hospital due to pale face and fatigue for over 20 years and unconsciousness for 1 d. The patient was diagnosed with aplastic anemia 20 years ago， and diagnosed with myelodysplastic syndrome at 6 months prior to admission. After admission， the venous blood samples were collected and cultured in aerobic and anaerobic conditions by automatic blood culture instrument. Then， the positive cultures were isolated. After Grams staining and anti-acid staining， the quality spectrum technique was used for identification. The diagnosis of Mycobacterium marinum infection was validated. The patient died from respiratory failure and heart failure after anti-infection intervention， immune therapy and alternative treatment. Mycobacterium marinum was gram-positive bacilli and positive for anti-acid staining， which could not be identified by conventional methods. Besides Grams staining and conventional methods， anti-acid staining and mass spectrum analysis should be performed to provide reliable evidence for the identification of uncommon bacteria.

【Key words】Mycobacterium marinum； Bloodstream infection； Nontuberculous mycobacteria

海分枝杆菌自然栖息于水中，对人类为条件致病菌，通过接触海水、淡水、水产品等途径感染皮肤和软组织，是非结核分枝杆菌感染所致皮肤和软组织感染的主要致病菌[1]。海分枝杆菌感染很少引起系统播散，但在免疫缺陷的患者中，其可侵犯黏膜下组织 、骨骼 、关节等深部组织[2]。2017年7月笔者从骨髓增生异常综合征患者的血液中分离出一株海分枝杆菌，现报道如下。

病例资料

一、病史及体格检查

患者女，46岁，因“面色苍白乏力20余年，意识模糊1 d”于2017年6月25日入我院。……