小肠嗜麦芽狭小滋养单胞菌感染导致的致命性慢性肠炎

作     者：Hellmig S. Ott S. Musfeldt M. S. Schreiber 成虹 

作者机构：Department of Gastroenterology Institute for Clinical Molecular Biology Christian- Albrechts- University Schittenhelmstr. 12 24105 Kiel Germany Dr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2005年第1卷第12期

页      面：30-31页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：慢性肠炎 嗜麦芽 单胞 吸收不良 感染性肠炎 胃肠道感染 呼气试验 肠道功能失调 细菌培养技术 慢性腹泻 

摘      要：Chronic diarrheal illness and malabsorption are challenging diagnostic and clinical problems. The identification of the causative pathogens that are involved in gastrointestinal infections is often difficult. It took 85 years after the first description of a case of intestinal lipodystrophy by GeorgWhipple in 1907 until the causative bacterium was characterized by using molecular genetics techniques. We here report the complicated clinical course of a young patient with chronic diarrhea accompanied by severe, life- threate- ning malabsorption with extensive weight loss. Histology and glucose hydrogen breath test were suggestive of a bacterial overgrowth syndrome in the small bow el, but standard culture- based techniques and serology failed to identify the causative bacteria. Thus, bacterial ribosomalDNA (16S ribosomal DNA) was extract ed from duodenal biopsy samples and analyzed by community fingerprinting and spe cies- specific polymerase chain reaction. Stenotrophomonas mal- tophilia was identified as the cause of chronic infectious enteritis. Only specific long- term antibiotic treatment with co- trimoxazole had a durable clinical effect and led to normalization of 16S ribosomal DNA profiles. This case shows the role of rare and uncommon bacteria in refractory and chronic human gastrointestinal infections. Genomic techniques, including 16S- based single- strand conformation polymorphism analysis, will play an increasing role in the diagnosis of chronic infections with facultatively pathogenic bacteria or in the clinical analysis of complex bacterial communities such as the intestinal bacterial microflora. Future enhancements in detection techniques will show that chronic bacterial infections are more frequent as a cause of gastrointestinal malfunction than com- monly thought.