背景:放线菌属为革兰氏阳性,专性厌氧棒,是胆囊炎的罕见原因。因为放线菌是厌氧菌,放线菌除了A.naeslundii外,很难在胆汁中存活。我们经历了一例由齿状溶胞杆菌引起的复发性急性胆囊炎。
方法:1例患者诊断为急性胆囊炎,治疗前后1个月,因复发性胆囊炎入院。胆汁的革兰氏染色显示革兰氏阳性棒和革兰氏阳性球菌。我们在胆汁培养中发现了齿状芽孢杆菌和MRSA,在血液培养中发现了MRSA。我们服用哌拉西林-他唑巴坦,然后将其改为氨苄西林-舒巴坦和万古霉素。患者行腹腔镜胆囊切除术,安全出院。
结论:据我们所知,这是第一例由齿状溶胞杆菌引起的胆囊炎。由放线菌引起的胆囊炎是罕见的。此外,放线菌胆汁培养阳性低,我们可能会忽略它。每当胆囊炎复发而没有任何胆道阻塞时,我们应该寻找隐藏在胆汁中的革兰氏阳性棒,例如齿形tolyticus,作为致病生物,即使胆汁培养是阴性的。
BACKGROUND: Actinomyces species are gram-positive, obligate anaerobic rods and are rare causes of cholecystitis. Because Actinomyces species are anaerobic bacteria, it is difficult for Actinomyces to survive in bile apart from A. naeslundii. We experienced a case of recurrent acute cholecystitis caused by A. odontolyticus.
METHODS: A patient had been diagnosed with acute cholecystitis and treated one month before and after that, admitted to our hospital because of recurrent cholecystitis. Gram stain of the bile revealed gram-positive rods and gram-positive cocci. We found A. odontolyticus and MRSA in bile culture and MRSA in blood culture. We administered piperacillin-tazobactam and then changed it to ampicillin-sulbactam and vancomycin. The patient underwent laparoscopic cholecystectomy and was discharged safely.
CONCLUSIONS: To our knowledge, this is the first case of cholecystitis caused by A. odontolyticus. Cholecystitis caused by Actinomyces species is rare. In addition, we may overlook it with the low positivity of bile cultures of Actinomyces. Whenever the cholecystitis recurs without any obstruction of the biliary tract, we should search for the gram-positive rods hidden in the bile, such as A. odontolyticus, as the causative organism, even if the bile culture is negative.