Title: Imported Pneumonia--what to worry about?
题目：“进口的”肺炎－需要警惕什么？
Author 作者: Jenny Reifel Saltzberg, MD, MPH

Case Presentation:
病例简介：
A 43 year old diabetic woman presents with dyspnea and a dry cough. Her vital signs are:  BP 84/42, HR 135 RR 37 T 38.5.  Lobar consolidation is seen on chest xray.  She decompensates and is intubated, a central line is placed, and IV fluids are started.  Her husband reports that they had just returned from  a vacation in Thailand one week earlier.
43岁的女性糖尿病病人因呼吸困难和干咳就诊，她的生命体征是：血压84／42，心率135，呼吸37，体温38。5。胸片显示大叶实变。因病情恶化而行气管插管，放置中心静脉，开始液体复苏。椐病人丈夫讲，一个星期前他们刚从泰国休假回来。
Clinical Question:
临床问题：
Does the recent travel change your choice of empiric antibiotics?
近期旅行会改变你的经验抗菌素的选择吗？
Answer:
答案：
The patient should also be covered for melioidosis, and infection caused by Burkholderia pseudomallei.
病人同时要得到针对由类鼻疽伯克氏菌导致的类鼻疽的抗菌素。
Infection can occur via direct contact with, inhalation of, or ingestion of the bacteria.
感染是通过直接接触，吸入，或食入细菌。
B. pseudomallei is highly endemic in Thailand and Northern Australia, but melioidosis has been contracted in the Americas and other parts of Asia and Australia. (True epidemiology is unknown due to difficulties in culturing the bacteria)
类鼻疽伯克氏菌在泰国和澳大利亚北部极为流行，但类鼻疽在美洲，亚洲和澳大利亚的其它区域也有发生。
Clinical presentation most frequently involves pulmonary infection, abscess formation, or bacteremia.
最常见的临床表现有肺部感染，脓肿形成，和菌血症。
Labs that don't have experience with this bacteria have difficulty culturing it and it is often misidentified.
对这个细菌没有经验的实验室在培养方面可能会有问题，甚至被误导。
Treatment is 10-14 days of ceftazidime or a carbapenem.
治疗主要是10－14天的头孢他啶或一个碳青霉烯类。
After recovery, the patient requires TMP-SMX for 3-6 months for bacterial eradication. 
病人恢复后，为彻底清除细菌，还需要3－6个月的复方新诺明。

Bottom Line:
要点：
Patients presenting with severe infections and recent travel to an endemic area should receive emperic antibiotics with ceftazidime or a carbapenem until another source is identified. 
对有严重感染和近期到流行区旅游的病人，应该给头孢他啶或一个碳青霉烯类，一直到诊断明确。

References 参考文献
Wiersinga WJ, Currie BJ, Peacock SJ.  Melioidosis. N Engl J Med. 2012;367(11):1035-1044.
http://www.cdc.gov/melioidosis/index.html