Aeromonas sobria sepsis in a
neutropenic patient
Ruggero ORLANDO, Lucia MASTRULLO, Donatella DE BLASI, Maria
Lucia BOFFA, Giacomo ZORZATO*, Eustachio MIRAGLIA
Divisione di Ematologia - Centro Emofilia e Trombosi - Centro
delle Microcitemie; * Laboratorio di Patologia Clinica; Ospedale
San Giovanni Bosco - A.S.L. NA 1 - Napoli - Italy
Correspondence: Ruggero Orlando, M.D., Divisione di Ematologia,
Centro Emofilia e Trombosi, Centro delle Microcitemie, Ospedale
San Giovanni Bosco, A.S.L. NA1, Via F.M. Briganti 255 - 80144
Napoli, Italy. Phone +39 081.2545343 - Fax +39 .081 2545301.
Email: ematoeumiranapoli@libero.it
Abstract
We report the case of a neutropenic patient with hematologic malignancy who developed a sepsis by Aeromonas Sobria, an emerging pathogen. Antimicrobial therapy with Ciprofloxacin and Amikacin was administered achieving complete recovery of infection.
Text
Aeromonas sobria (A. sobria) is
an aerobic, gram-negative, bacillus, usually living in fresh- or
sea- water where often infects the acquatic fauna. It also may be
isolated on wash-basin drains, water pipes, taps and distilled
water installations. Such an organism is a pathogen which is
emerging as a cause of hospital bacteremia in immunocompromized
patients whose main infection sources are hygienic installations.
In comparison with bacteremia by other gram-negative bacilli, that
caused by A. sobria is less frequent, but ofte represents a
therapeutic problem for its resistance to many antibiotics except
fluoroquinolones, as ciprofloxacin which is instead effective
against it. We report below the case of a neutropeni patient with
an hematologic malignancy who developed an A: sobria sepsis.
A 79-years old woman was admitted to our hospital with
asymptomatic pancytopenia. Phisical examination revealed only a
mild hepatomegaly, without spleen and lymph nodes enlargement;
body temperature was normal. Complete blood count included
hemoglobin level of 8.4 gr./dl, platelet count of 138.000/mmc and
white blood count of 1100/mmc with neutropenia (418/mmc) relative
lymphocytosis (60%) and blasts in peripheral blood smera. By bone
marrow examination and immunophenotypic analysis, acute myeloid
leukaemia diagnosis was formulated. Antileukemic chemioterapy
(with Idarubicin+Cytarabine+Etoposide) was started and carried out
for 5 days. After 4 days neutrophil count dropped even more
(6/mmc). In the next days intermitted fever (with thermic peak at
39,2°C) occurred. An empirical antibacterial therapy i.v.
(i.e. Teicoplanine 400 mg./die+ Piperacillin/Tazobactam 4,5 gr.x
4/die + Imipenem 0.5 gr.x 3/die) associated with antifungine and
antiviral agents (respectively: fluconazole 200 mg./die i.v. and
Acyclovir 250 mg. X 3/die i.v.) was so started and
myelostimulating trial with prednisone (50 mg./die os) was
performed. Serial blood and urine cultures, as well as other
microbiological studies on pharyngeal, rectal and vaginal material
were initially negative. Toxoplasma gondii, rubeola
cytomegalovirus and herpesvirus simplex 1-2 sierology didn't prove
an ongoing infection. Chest radiograph showed mild strengthenng
without lung consolidation. After 12 days of persistent fever
despite antimicrobial therapy, A. sobria was isolated from blood
culture. According to relative antibiogrm (Table
1), specific antibiotic
therapy was undertaken, substituting Piperacillin/Tazobactam and
Imipenem by Amikacin (1,5 gr./die i.v.) and Ciprofloxacin (400 mg.
X 2/die i.v.) added to Teicoplanine and Fluconazole. Persisting
furthermore severe neutropenia, administration of recombinant
human granulocyte-colony stimulating factor (rh G-CSF) - 300
mcg./die s.c. - was addes. After one week of combination
antibiotic therapy (Teicoplanine + Amikacin + Ciprofloxacin +
Fluconazole) fever disapparead. A. sobria didn't turn out any
longer from serial blood cultures. Almost at the same time
leucocyte and granulocyte count gradually recovered reaching
normal values within 10 days while myelostimulating treatment was
continuing. In conclusion, the above case illustrates efficacy of
Ciprofloxacin and Amikacin in the management of infections caused
by A. sobria, a "difficult" organism. Undoubtedly white blood
recovery contributed to success of antibiotic therapy.
