副流行性感冒嗜血桿菌（Haemophilus parainfluenzae）與感染性關節炎

Haemophilus parainfluenzae and Infectious Arthritis

我們接到一位70歲男性是由於膝蓋疼痛腫脹無法行走，且發燒不退而至本院骨科求診，他過去曾經因骨關節炎而接受過全膝關節置換術，6個月之後又因為膝蓋疼痛腫脹而進行過關節鏡清瘡術，術後仍有反覆發炎現象，這次就診經評估需做滑膜切除術而住院，取其關節組織做病理切片檢查，同時取關節液做鏡檢與細菌和黴菌與結核菌培養，病理切片經H&E染色看到許多的組織細胞，多型核白血球和淋巴球；黴菌與結核菌培養結果均為陰性，細菌培養則長出很少量的格蘭氏陰性球桿菌，取菌落測試其對第V因子和第X因子的需求，結果只需第V因子即可生長，又以Vitek 2（bioMérieux, Inc., Durham, NC）NH卡鑑定，鑑定結果為副流行性感冒嗜血桿菌（Haemophilus parainfluenzaee），證實為感染性關節炎。本案例住院期間以萬古黴素（Vancomycin）治療，而在細菌培養之鑑定及抗生素敏感性試驗結果發出之後，改以Levofloxacin 500 mg／tab（Cravit錠）治療，發燒與疼痛情形獲得改善。我們的結論是：臨床微生物實驗室對於病源菌的分離鑑定與抗生素敏感性試驗結果的提供，對於正確的抗生素選擇扮演著很重要的角色。

The Department of Orthopedics of our hospital had a 70-year-old male patient with persistent fever who could not walk because of painful and swollen knee. He had undergone total knee replacement to treat his osteoarthritis and received arthroscopic debridement 6 months later to treat his painful and swollen knee. Repeated inflammation was observed after the surgeries. In his visit to our hospital, the physician assessed his condition and prescribed that the patient needed to be hospitalized and receive synovectomy. Some of the joint tissue was obtained for biopsy examination. In addition, synovial fluid was obtained for microscopic analysis and culture of bacteria, fungi, and Mycobacterium. Biopsy with hematoxylin and eosin staining showed many tissue cells, polymorphonuclear neutrophils, and lymphocytes. The culture results of fungi and Mycobacterium were negative. The bacterial culture yielded only a small number of Gram-negative bacteria. Colony-forming units were used to test the bacterial requirement for factors V and X; the results showed that only factor V was required for the bacterium to multiply. It was further identified as Haemophilus parainfluenzae by using VITEK 2 (bioMérieux, Inc., Durham, NC) NH ID card. That confirmed infectious arthritis was caused by Haemophilus parainfluenzae. During the hospitalization period of the patient, vancomycin was used for treatment. After the bacterial identification and antibiotic sensitivity test results were confirmed, Levofloxacin 500 mg /tab (Cravit) was used to treat the patient. The fever and pain conditions were reduced. We concluded that clinical microbiological laboratory plays a crucial role in bacterial identification, providing antibiotic sensitivity test results, and selecting the correct antibiotics for treatment.