PDF(Pubmed)
Abstract：
Anncaliia algerae, a microsporidium, has risen to prominence as an opportunistic pathogen, particularly afflicting individuals who are immunocompromised with conditions such as rheumatoid arthritis, organ transplantation, and hematologic malignancy. Surprisingly, despite its recognized impact, the identification of A algerae in ascitic fluid has not been documented. As such, we pinpointed A algerae as the probable instigator of ascitic accumulation in a patient with a history of acute myeloid leukemia and extended periods of immunosuppressive therapy. For this patient, there were no signs of A algerae-related infections (eg, myositis), vocal cord involvement, or disseminated infection. The presence of A algerae was finally identified by next-generation metagenomic sequencing analysis of the ascitic fluid. Clinical presentation was characterized by elevated C-reactive protein levels (110.7 mg/L), diminished platelet count (48 × 109/L), abdominal distension secondary to ascitic fluid accumulation, and lower limb pain, and it showed marked improvement following a 4-day regimen of sulfamethoxazole/trimethoprim and albendazole. Despite this promising response, the patient succumbed to aspiration of vomitus. This case underscores the importance of considering rarer organisms, such as A algerae infection, in patients who are immunocompromised and present with unexplained ascites accumulation. It highlights the potential effectiveness of sulfamethoxazole/trimethoprim and albendazole in managing such cases. Further research is warranted to elucidate optimal management strategies and improve outcomes in similar clinical scenarios.
摘要：
白天鹅膏,一个小孢子虫,已经成为一种机会病原体，特别是患有类风湿关节炎等免疫功能低下的个体，器官移植,和恶性血液病.令人惊讶的是,尽管它有公认的影响，尚未记录在腹水中鉴定A。因此，我们指出，在有急性髓细胞性白血病病史和长期免疫抑制治疗的患者中，Algerae可能是腹水蓄积的诱因。对这个病人来说,没有甲藻相关感染的迹象(例如，肌炎)，声带受累，或播散性感染。通过对腹水的下一代宏基因组测序分析，最终确定了Aalgerae的存在。临床表现以C反应蛋白水平升高（110.7mg/L）为特征，血小板计数减少（48×109/L），腹胀继发腹水积聚，下肢疼痛，在磺胺甲恶唑/甲氧苄啶和阿苯达唑4天的治疗方案后，它显示出明显的改善。尽管有这种有希望的反应，病人因呕吐物误吸而死亡。这个案例强调了考虑更稀有生物的重要性，如藻类感染，免疫功能低下并存在无法解释的腹水积聚的患者。它强调了磺胺甲恶唑/甲氧苄啶和阿苯达唑在处理此类病例中的潜在有效性。进一步的研究是必要的，以阐明最佳的管理策略和改善结果在类似的临床情况。
