PDF(Pubmed)
Abstract：
Tularaemia is a highly infectious, zoonotic disease caused by Francisella tularensis, which has become increasingly prevalent over the past decade. Depending on the route of infection, different clinical manifestations can be observed. We report a case of typhoidal tularaemia presenting as a febrile illness with gastrointestinal symptoms in a patient in her mid-80s. During the acute illness phase and in the context of alcohol-related liver cirrhosis, the patient developed progressive ascites. During paracentesis, spontaneous bacterial peritonitis was consistently reported. Blood culture revealed Gram-negative bacilli identified as F. tularensis upon microscopic examination. Immediate clinical improvement was observed after adaptation to a pathogen-specific antibiotic regime. Typhoidal tularaemia presents general, non-specific symptoms without the local manifestations seen in other forms of the disease, thus representing a diagnostic challenge. In the case of protracted fever and if the epidemiological context as well as possible exposure are compatible, tularaemia should be considered in the differential diagnosis.
摘要：
图拉血症是一种高度传染性疾病，人畜共患疾病，在过去的十年里变得越来越普遍。根据感染途径的不同,可以观察到不同的临床表现。我们报告了一名80年代中期患者的伤寒土豆病，表现为发热性疾病并伴有胃肠道症状。在急性疾病阶段和酒精相关性肝硬化的背景下，患者出现进行性腹水。在穿刺期间,自发性细菌性腹膜炎的报告一致.血液培养显示，经显微镜检查，革兰氏阴性杆菌被鉴定为土拉氏菌。在适应病原体特异性抗生素方案后观察到立即的临床改善。伤寒图拉血症表现一般，非特异性症状，没有其他疾病形式的局部表现，因此代表了诊断挑战。在长期发烧的情况下，如果流行病学背景和可能的接触是兼容的，在鉴别诊断中，应考虑到塔拉血症。
