致毒白喉杆菌引起的败血症休克、感染性心内膜炎、败血症栓塞和弥漫性血管内凝血：病例报告
{"_":"Septic Shock, Infective Endocarditis, Septic Embolization and Disseminated Intravascular Coagulation Caused by a Toxigenic Strain: A Case Report.","i":["C. diphtheriae"]}
摘要(中文译文)
白喉是由白喉棒状杆菌引起的急性传染病。尽管全球范围内曾发生数次暴发，但目前在工业化国家已被视为罕见疾病。临床表现通常表现为口咽部病变，但非产毒菌株中已有罕见的全身受累（主要为心内膜炎）病例报道。我们报告一例因白喉棒状杆菌感染而出现感染性休克、弥散性血管内凝血及多器官衰竭的患者。该病原体进一步鉴定为高毒力产毒菌株。感染性心内膜炎伴二尖瓣和主动脉瓣赘生物导致早期多器官脓毒性栓塞。主要表现包括大面积脑卒中、肝功能损害、心力衰竭和急性肾损伤。与由该病原体引起的典型感染形式不同，本例无气道或皮肤受累的证据。此外，除血培养外，其他检查（咽拭子、支气管肺泡灌洗液、尿培养）均未检出该细菌阳性。我们呈现的这份报告描述了一例具有诸多非典型特征的白喉棒状杆菌感染：(i) 缺乏任何特征性体征或症状；(ii) 广泛的心内膜炎性病变（对产毒菌株而言极为罕见）；(iii) 早期脓毒性栓子形成，并迅速进展为多器官衰竭；(iv) 检出弥散性血管内凝血。尽管弥散性血管内凝血是感染性休克的已知并发症，与病原体无关，但根据我们的文献检索，这是成人中由白喉棒状杆菌感染驱动的第二例已知病例。
Abstract
Diphtheria is an acute infectious disease caused by . Despite several worldwide outbreaks, it is now considered a rare disease by industrialized countries. Clinical manifestations usually account for oropharyngeal lesions, but rare cases of systemic involvement (mainly endocarditis) have been described among non-toxigenic strains. We report the case of a patient who experienced septic shock, disseminated intravascular coagulation and multiorgan failure due to infection. The pathogen was further characterized as a highly toxigenic strain. Infective endocarditis with mitral and aortic valve vegetations led to early multiorgan septic embolization. Major stroke, liver function impairment, heart failure and acute kidney injury were the main findings. Unlike the typical forms of infection caused by this pathogen, there was no evidence of airway or skin involvement. Furthermore, apart from hemocultures, none of the other investigations (pharyngeal swabs, bronchoalveolar lavages, urine culture) ever tested positive for the bacteria. The report we present describes a case of infection with many atypical characteristics: (i) lack of any pathognomonic signs or symptoms; (ii) extensive endocarditic process (very uncommon for toxigenic strains); (iii) early septic emboli development, with rapid evolution to multiorgan failure; (iv) detection of disseminated intravascular coagulation. Despite disseminated intravascular coagulation being a known complication of septic shock, regardless of the etiological agent, according to our literature research, this is the second known case driven by infection in an adult.
如何引用
AMA
Matteo Fabris, Ivan Martinello, Flavio Bassi. {"_":"Septic Shock, Infective Endocarditis, Septic Embolization and Disseminated Intravascular Coagulation Caused by a Toxigenic Strain: A Case Report.","i":["C. diphtheriae"]}. Healthcare (Basel, Switzerland). 2026; doi:10.3390/healthcare14131890.
APA
Matteo Fabris, Ivan Martinello, Flavio Bassi (2026). {"_":"Septic Shock, Infective Endocarditis, Septic Embolization and Disseminated Intravascular Coagulation Caused by a Toxigenic Strain: A Case Report.","i":["C. diphtheriae"]}. Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare14131890
GB/T 7714
Matteo Fabris, Ivan Martinello, Flavio Bassi. {"_":"Septic Shock, Infective Endocarditis, Septic Embolization and Disseminated Intravascular Coagulation Caused by a Toxigenic Strain: A Case Report.","i":["C. diphtheriae"]}[J]. Healthcare (Basel, Switzerland), 2026 doi:10.3390/healthcare14131890.
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