Key words: Haernophilus aphrophilus, mitral regurgitation,

Transcription

1 Key words: Haernophilus aphrophilus, mitral regurgitation, infective endocarditis

2 (PCG), ampicillin (ABPC), oxacillin (MPIPC), piperacillin (PIPC), sultamicillin (SBTPC), cefaclor (CCL), cefazolin (CEZ), cefotiam (CTM), sulbactam/cefoperazone (SBT/CPZ), cefotaxime (CTX), cefuzonam (CZON), ceftazidime (CAZ), imipenem/cirastatine (IPM), minocycline (MINO), fosfomycin (FOM), clin-

3 Table 1 Laboratory data on admission Fig. 1 Clinical course of a 62 year-old female patient with infective endocarditis due to Haemophilus aphrophilus

4 Table 2 Physiological characteristics of five H. aphrophilus isolates Table 3 Biochemical characteristics of 5 isolates of Haemophilus aphrophilus From Bergey's manual of systematic bacteriology volume 1, 1984 From Cowan and Steel's manual for the identification of medical bacteria, Third Edition, 1993

5 Table 4 Zone diameter of antibiotics against five isolated H. aphrophilus strains Table 5 MICs of antibiotics against 5 Haemophilus aphrophilus isolates Sites of blood collection No.1: left small saphenous vein No.2: left median cubital vein No.3: right median cubital vein No.4: femoral artery No.5: median cubital vein S: Descendant of smooth colony, 1.0mm in diameter R: Descendant of rough colony, 0.5mm in diameter

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7 & Urvaskova, P.: Haemophilus aphrophilus isolated from blood. Zentralbl. Bakteriol., 273: , ) Dauson, S.J. & White, L.A.: Treatment of Haemophilus aphrophilus endocarditis with Ciprofloxacin. J. Infect., 24: , ) Goldweig, H. G., Masten, J. M. & Castaneda, A. R.: Haemophilus aphrophilus endocarditis in a patient with a mitral valve prothesis, case report and review of the literature. J Thor. Card. Surg., 63: , ) Sutter, V. L. & Finegold, S. M.: Haemophilus aphrophilus infections : Clinical and Bacteriologic Studies. Ann. New York Acad. Sci., 174: , ) Page, M. I. & King, E. O.: Infection due to Actinobacillus actinornycetemcomitans and Haemophilus aphrophilus. New Eng. J. Med., 28: , ) Webb, C. H. & Hogg, G. M.: Haemophilus aphrophilus endocarditis. Br. J. Clin. Pract., 44: , ) Aldova, E., Marova, J., Stafova, J., Kudrna, L. 1) Khairat, 0.: Endocarditis due to new species of Haemophilus. J. Path. Bacteriol., 50: ) Gribble, M. J. & Hunter, T.: Haemophilus 505, aphrophilus vertebral osteomyelitis: A case 2) Kilian, M.: Haemophilus. In Manual of Clinical Microbiology, 5th ed., (Balows, A., Hausler, report and literature review. Diag. Microbiol. Infect. Dis., 8: , W. J. Jr., Herrmann, K. L., Isenberg, H. D. & 16) Berenson, C. S. & Mangi, R. J.: Haemophilus Shadomy, H. J. (ed.), p , Amer. Soc. aphrophilus sternal osteomyelitis. South. Medical J., 81: , Microbiol., Washington, D. C., ) Farrand, R. J., Maccabe, A. F. & Jordan, O. W.: Haemophilus aphrophilus endocarditis. J. Clin. Path., 22: , ) Kilian, M. & Bibestein, E.: Genus II. Haemophilus weislow at al In Bergey's Manual of Systematic Bacteriology, Vol. 1, (Kreig, N. R. & Holt, J. G., ed.), p , Williams & Wilkins, Baltimore/London, ) King, E. O. & Tatum, H. O.: Actinobacillus actinomycetemcornitans and Haernophilus aphrophilus. J. Infect. Dis., 111: 85-94, ) Tomas, E.R.: Haemophilus aphrophilus endocarditis with a probable primary dental focus of infection. Chest, 80: , 1981.

8 Occurrence and biochemical properties of Haemophilus species in pharyngeal flora of healthy individuals. Microbiol. Immunol., 26: , ) Bieger, R. C., Brewer, N. S. & Washington, J.A.: Haemophilus aphrophilus: A microbiologic and clinical review and report of 42 cases. Medicine, 57: , ) Kawakami, Y., Okimura, Y. & Kanai, M.: 30) Kraut, M. S., Attebery, H. R., Finegold, S. M. & Sutter, V. L.: Detection of Haernophilus aphrophilus in the human oral flora with a selective medium. J. Infect. Dis., 126: , Haemophilus aphrophilus Isolated from the Blood of a Patient with Infective Endocarditis Ikuko YOSHIOKA, Hiroko HASHIMOTO, Koji YUDA & Naofumi NESUMI Department of Medical Laboratory, Kansai Denryoku Hospital Mayumi INOUE, Katsuhisa ISHII, Takaharu SAITOH & Akira SAKAI Department of Medicine, Kansai Denryoku Hospital Yoshimasa KOSAKO Japan Collection of Microorganisms, RIKEN, Institute of Physical and ChemicalResearch On July 1994, a 62-year-old female, having a history of mitral regurgitation,was admitted because of high fever, hematuria and conjunctival petechiae. She was diagnosed as having infective endocarditis with mitral valve vegetation proved by ultrasonic cardiography. The gram negative rods were isolated from blood cultures performed five times, performed prior to the administration of antibiotics. The isolates were identified as strains of H. aphrophilus. After two days of treatment with PCG (12 million units/day), the organism became undetectable from the blood. Since the minimal inhibitory concentrations (MICs) of PCG and ABPC were ranged between ,ug/ml and ,ug/ml, respectively, ABPC was selected as a first choice antibiotic instead of PCG. ABPC was given 12 g/day for the first 3 days, then6 g/day for 28 days, followed by 3 g/day for 7 days. The patient recovered and was discharged after the 55 hospital days. H. aphrophilus grew on BTB lactose agar, chocolate agar and sheep blood agar,but failed to grow on MacConkey agar. H. aphrophilus produced smooth transparent nonhaemolytic micro colonies after 48 hours on sheep blood agar and chocolate agar plates. Atmosphere with 5% CO2 failed to enhance their growth. All the five strains of H. aphrophilus isolated, required neither factors V nor X. Positive synthesis of porphyrin from s-aminolevlinic acid confirmed their ability to grow without X factor. For the correct identification of H. aphrophilus strains, fermentation test of glucose, lactose, maltose and sucrose in either phenol red broth or CTA medium are necessary. Miniaturized identification kits, such as ID test HN 20 rapid and the Vitek NHI card could not identify any of our isolates.