每日一题_2023.05.07

A 19-year-old man who recently emigrated from Mexico comes to the emergency department because of blood in his sputum. The patient mentions he has had weight loss and night sweats. On examination, the patient has a fever and bronchial breath sounds with crepitant rales. Laboratory tests show lymphocytosis and an increased erythrocyte sedimentation rate. X-ray of the chest shows a calcified lung lesion and hilar lymphadenopathy. Of the following, which is the stain used to identify the most likely infectious organism?

一名最近从墨西哥移民的19岁男子因痰中带血来到急诊室。患者提到他有体重减轻和盗汗。检查时，患者有发热和支气管呼吸音，并伴有嘶嘶的啰音。实验室检查显示淋巴细胞增多和红细胞沉降率增加。胸部x线显示肺钙化病变和肺门淋巴结肿大。以下哪一种染色剂是用来鉴别最有可能感染的微生物的?

(A) Congo red 刚果红

(B) Giemsa 姬姆萨染色

(C) India ink 墨子染色

(D) Periodic acid-Schiff 过碘酸-希夫

(E) Ziehl-Neelsen 抗酸染色

答案解析：

该患者极有可能有结核分枝杆菌感染。结核分枝杆菌是一种需氧、革兰氏阳性、抗酸杆菌，Ziehl- Neelsen染色用于显示抗酸菌。有利于TB诊断的特征包括肺部症状、移民身份、盗汗、体重减轻和胸部x线表现。已知原发性TB会导致Ghon复合体，在x线成像上表现为钙化。Ghon复合体是脑实质病变和肺门和/或纵隔淋巴结受累的组合。由于病理性肉芽肿形成，病变钙化。继发性结核病表现为空洞性病变，多见于免疫功能低下的患者。其他可以表现为肺门/纵隔淋巴结的病理学是淋巴瘤和结节病，使得革兰染色在诊断中很重要。

正确答案：E