Haemophilus aphrophilus

Transcription

1 Haemophilus aphrophilus Haemophilus aphrophilus 5-10% CO 2. Haemophilus X V,,,,. H. aphrophilus 2,. 38 H. aphrophilus coagulase-negative staphylococcus (CNS). 3 H. aphrophilus CNS. H. aphrophilus.. H. aphrophilus ampicillin cefotaxime, CNS oxacillin vancomycin. H. aphrophilus CNS ceftriaxone, teicoplanin, gentamicin. Haemophius,, [1], X (hemin) V(nicotin amide adenine dinucleotide). Haemophilus aphrophilus 5-10% CO 2 Haemophilus X V [2,3]. H. aphrophilus [4].,,,,, [2,4]. H. aphrophilus, [5,6]. : 05 / 8 / 5 : 05 / 10 / 13 : ( ) 134 TEL : 02) FAX : 02) deyong@yumc.yonsei.ac.kr H. aphrophilus coagulase-negative staphylococcus (CNS) ,.. 110/80 mmhg, 120/, 40/, 38.,.,.. 39,770/L ( 92%, 3%, 2%), 5.9 g/dl 18.0% 165,000/L. sodium 138 meq/l, potassium 4.72 meq/l, chloride

2 Table 1. Biochemical characteristics of some species of HACEK group and the isolate from this report Test H. aphrophilus* H. paraphrophilus* A. actinomycetemcomitans* E. corrodens* YMC 03/06/B3034 X factor requirement V factor requirement + Indole Urease Ornithine decarboxydase + Lysine decarboxylase + Fermentation of Glucose Sucrose Lactose Mannitol Nitrate reduction Catalase + * Data from references 1 and 2 D, differences encountered D 99.5 meq/l, CO meq/l. BUN/creatinine 45.5/1.4 mg/dl, 124 mg/dl, NT-pro- BNP >35,000 pg/ml. aspartate aminotransferase/alanine aminotransferase 52/115 IU/L, 6.1 mg/dl, 4.7 mg/dl. iron 41 g/ dl (: g/dl), TIBC 192 g/dl (: g/dl), ferritin ng/ml (: ng/ml). ph 5.0, protein 2+, RBC 3+, bilirubin 1+. 3, trypticase soy broth 40 ml thioglycollate medium 40 ml 3 5 ml 35. 2,. 24. mannitol salt agar, DNase coagulase CNS. MacConkey chocolate chocolate 24 (Fig. 1). Triple sugar iron H 2 S. Oxidase catalase, table 1. Vitek NHI card (biomerieux, Marcy l'etoile, France) H. aphrophilus 50%/H. paraphrophilus 49% (Bionumber ). X V. Staphylococcus aureus V, -aminolevulinic acid X H. aphrophilus. 2., H. aphrophilus. H. aphrophilus ampicillin, ampicillin-sulbactam, cefotaxime, ceftazidime, cefepime, aztreonam, imipenem, meropenem, levofloxacine, tetracycline cotrimoxazole, CNS oxacillin, cotrimoxazole, clindamycin, perfloxacin, teicoplanin, vancomycin penicillin, tetracycline, fusidic acid. Fig. 1. A microscopic finding of H. aphrophilus. Gramnegative coccorods and rods are seen. (Gram stain, 1,000)

3 H. aphrophilus Fig. 2. Septic emboli in Brain MRI. An enhancing nodule (arrow) in left cerebellum is noted. Piperacillin-tazobactam, ciprofloxacin, roxithromycin, H. aphrophilus CNS teicoplanin, ceftriaxone, gentamicin (Fig. 2). 35. H. aphrophilus CNS 1. S. aureus, CNS, Streptococcus species, HACEK (Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella Kingae) [7]. HACEK 5-10% [8] [8]. HA- CEK 3%, [4]., HACEK [8].. 16S rrna [6]. HACEK H. aphrophilus Haemophilus [6]. H. aphrophilus HACEK, A. actinomycetemcomitans E. corrodens [2]. oxidase E. corrodens, catalase indole C. hominis lactose A. actinomycetemcomitans. catalase A. actinomycetemcomitans catalase H. aphrophilus, H. paraphrophilus V. [9] %, % CNS [7]. CNS, staphylococci CNS [10]. CNS CNS. H. aphrophilus,, [8,11,12]. H. aphrophilus [11,13]. 2 [5,6].,.., H. aphropilus [5]. HACEK ampicillin gentamicin [8]., H. aphrophilus ampicillin [5,6,14],. Haemophilus -lactamase ampicillin

4 ampicillin -lactamase cephalosporin [8]. H. aphrophilus CNS penicillin oxacillin vancomycin. 3-7% [7], H. aphrophilus CNS. H. aphrophilus CNS teicoplanin, ceftriaxone, gentamicin. H. aphrophilus. 1. Kilian M. Haemophilus. In: Murray PR, Baron EJ, Jorgensen JH, Pfaller MA, Yolken RH, eds. Manual of clinical microbiology. 8th ed. Washington; ASM press, 2003; Chong Y, Kim TS, Lee SY, Sul JH, Yang SI, Lee EW. Isolation of Haemophilus aphrophilus from Five Clinical Specimens. J Korea Soc Microbiol 1985;20: Weyant RS, Moss CW, Weaver RE, Hollis DG, Jordan JG, Cook EC, et al. Identification of Unusual Pathogenic Gram-Negative Aerobic and Facultatively Anaerobic- Bacteria. 2nd ed. Baltimore; Williams & Wilkins, 1996; Paju S, Carlson P, Jousimies-Somer H, Asikainen S. Actinobacillus actinomycetemcomitans and Haemophilus aphrophilus in systemic and nonoral infections in Finland. APMIS 2003;111: Park SS, Hong SI, Park MH, Suk JS, Kim SI. Isolation of Haemophilus aphrophilus from the Blood of a Patient with Subacute Bacterial Endocarditis. J Clin Pathol and Quality Assuarance 1985;7: Cha CH, Shin HB, Jang S, Kim MK, Kim YS, Song JK, et al. A Case of Haemophilus aphrophilus Endocarditis. Korean J Clin Microbiol 2003;6: Mylonakis E and Calderwood SB. Infective endocarditis in adults. N Engl J Med 2001;345: Brouqui P and Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 2001;14: Dogan B, Asikainen S, Jousimies-Somer H. Evaluation of two commercial kits and arbitrarily primed PCR for identification and differentiation of Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and Haemophilus paraphrophilus. J Clin Microbiol 1999;37: Huebner J and Goldmann DA. Coagulase-negative staphylococci: role as pathogens. Annu Rev Med 1999;50: Isom JB, Gordy PD, Selner JC, Brown LJ, Willis M. Brain Abscess Due To Haemophilus Aphrophilus. N Engl J Med 1964;271: Akhondi H and Rahimi AR. Haemophilus aphrophilus endocarditis after tongue piercing. Emerg Infect Dis 2002;8: Abla AA, Maroon JC, Slifkin M. Brain abscess due to Haemophilus aphrophilus: possible canine transmission. Neurosurgery 1986;19: Colson P, La Scola B, Champsaur P. Vertebral infections caused by Haemophilus aphrophilus: case report and review. Clin Microbiol Infect 2001;

5 H. aphrophilus Isolation of Haemophilus aphrophilus and Coagulase-Negative Staphylococci from the Blood of a Patient with Prosthetic Valve Endocarditis Chang Ki Kim 1, Injoo Cho 1, Youn Hee Park 1, Kyoung Ho Roh 1, Dongeun Yong 1,3,4, Kyungwon Lee 1,3,4, June Myung Kim 2,3,4, and Yunsop Chong 1,3 Departments of Laboratory Medicine 1, Internal Medicine 2 ; Research Institute of Bacterial Resistance 3 ; and Brain Korea 21 Project for Medical Sciences 4, Yonsei University College of Medicine, Seoul, Korea is a facultative anaerobic, gram-negative coccobacillus or bacillus and its growth is stimulated by 5 to 10% CO 2. Most species require either exogenous X or V factor or both to grow, but can grow without these factors. rarely causes invasive infections such as endocarditis, septicemia, pneumonia and peritonitis in human. Two cases of infective endocarditis by have been reported in Korea. However, there has been no report of polymicrobial endocarditis by and other bacteria. We isolated and coagulase-negative staphylococci (CNS) from the blood of a 38-year-old woman with prosthetic valve endocarditis. She underwent an emergent operation and a culture of the prosthetic valve grew. Brain abscess was developed at hospital day was susceptible to all antibiotics tested such as ampicillin and cefotaxime, and CNS was susceptible to oxacillin and vancomycin. The patient responded well to therapy with ceftriaxone, teicoplanin, and gentamicin., Coagulase-negative staphylococci, Endocarditis Address reprint requests to : Dongeun Yong, M.D., Department of Laboratory Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul , Korea. TEL FAX deyong@yumc.yonsei.ac.kr