背景:结核病(TB),全世界死亡的主要原因之一,在土著人民中发病率较高。尽管不常见,自身免疫性溶血性贫血(AIHA)已被认为是发展分枝杆菌感染的风险条件,作为免疫抑制治疗的结果。TB,反过来,可能是继发感染的诱发因素。
方法:这里我们介绍一个来自哥伦比亚的28岁土著妇女的案例,先前诊断为AIHA和肺结核。尽管有各种治疗方法,治疗和医疗干预,患者在多种原因导致的严重髓质再生症后死亡,包括免疫抑制治疗的继发性骨髓毒性和继发性播散性感染,金黄色葡萄球菌感染,肺炎克雷伯菌和光滑念珠菌,被鉴定为耐药微生物。一起,这导致了严重的临床并发症.尸检时诊断为侵袭性曲霉病。
结论:本报告提出了AIHA的罕见发现,其次是TB,并强调了应对共感染的巨大挑战,特别是耐药病原体。它还旨在促使政府和公共卫生当局将注意力集中在预防上,结核病的筛查和管理,特别是在脆弱的社区中,比如土著人。
BACKGROUND: Tuberculosis (TB), one of the leading causes of death worldwide, has a higher incidence among indigenous people. Albeit uncommon, autoimmune hemolytic anemia (AIHA) has been deemed a risk condition to develop mycobacterial infection, as a result of the immunosuppressive treatments. TB, in turn, can be a predisposing factor for secondary infections.
METHODS: Here we present a
case of a 28-year-old indigenous woman from Colombia, previously diagnosed with AIHA and pulmonary TB. Despite various treatments, therapies and medical interventions, the patient died after severe medullary aplasia of multiple causes, including secondary myelotoxicity by immunosuppressive therapy and secondary disseminated infections, underlining infection by Staphylococcus aureus, Klebsiella pneumoniae and Candida glabrata, which were identified as drug-resistant microorganisms. Together, this led to significant clinical complications. Invasive aspergillosis was diagnosed at autopsy.
CONCLUSIONS: This report presents a rarely finding of AIHA followed by TB, and highlights the great challenges of dealing with co-infections, particularly by drug resistant pathogens. It also aims to spur governments and public health authorities to focus attention in the prevention, screening and management of TB, especially among vulnerable communities, such as indigenous people.