全身性紅斑性狼瘡病人罹患沙門氏菌感染──南台灣某醫學中心17年之經驗

Salmonella Infection in Systemic Lupus Erythematosus － Seventeen-year Experience at a Medical Center in Southern Taiwan

一般而言，全身性紅斑性狼瘡（systemic lupus erythematosus）的病人得到感染的機會比正常人來得高，尤其是沙門氏菌（salmonella）的感染更是值得注意，利用回溯性研究，我們統計高雄長庚紀念醫院從1986年1月至2002年12月，17年期間，因全身性紅斑性狼瘡併發沙門氏菌感染而住院的病患，共有28位，其中五位患者之沙門氏菌感染有復發情形，故總共33位病患數做分析。這些病患中只有一位是男性，其餘皆為女性病人，平均年齡28.8歲，大部分的病人在感染當時是處於紅斑活動期（75.8% SLEDAI 大於4分），有二位病人是因沙門氏菌感染住院後，才初次診斷為全身性紅斑性狼瘡；29位病人（87.9%）在感染前一個月內都曾經使用過類固醇，3位病人（9.1%）曾使用過免疫抑制劑，而病人最常見的症狀為發燒、寒顫（93.9%），大部分病人（66.7%）白血球的數目在正常範圍內，所有沙門氏菌感染的診斷主要基於微生物培養結果，有最高比例（93.9%）的陽性培養結果來自於血液檢體，而培養出的菌種以Salmonella group B （57.2%）為主，有無復發沙門氏菌感染的病人，其臨床表現、實驗數值與預後並無顯著的差異。我們的病人僅一例因敗血症合併多重器官衰竭而死亡，死亡率3.3%；因此，沙門氏菌感染對於全身性紅斑性狼瘡病人發生敗血症時是需列入鑑別診斷的疾病之一。

It is well recognized that patients with systemic lupus erythematosus (SLE) have an increased susceptibility to infection, notably salmonellosis. We retrospectively report 33 cases of salmonella infection in 28 patients with SLE at Chang Gung Memorial Hospital, Kaohsiung during the period 1986 Jan- 2002 Dec. All the patients were woman except one man, with a mean age of 28.8 years. Most salmonella infections occurred during the periods of active SLE (75.9%, SLEDAI >4), 2 cases occurring concurrently with the first presentation of SLE. At the onset time of salmonella infection, 29 cases (87.9%) were taking steroids and 3 cases (9.1%) were taking immunosuppressive drugs. Fever and chill were the most common clinical manifestations. The majority (66.7%) of patients had normal leukocyte count in salmonella infection. Diagnosis was based on the isolation of the microorganism, mostly from blood cultures (93.9%). The most common isolated bacillus was Salmonella group B. Five patients had recurrent infections, but there was no significant difference between recurrence and non-recurrence groups in our study. Only one patient died in our cases with the mortality rate of 3%. According to our study, salmonella bacteremia should be taken into account in the differential diagnosis of sepsis in SLE patients.