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A Case of Biliary Sepsis Caused by Hafnia Alvei in a Patient with Cholangiocarcinoma

담관암종 환자에게 발생한 Hafnia Alvei에 의한 담도 패혈증 1예

  • Kim, Min-Kyung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Ji-Soo (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Ma, Dae-Won (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yun, Gi-Young (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lim, Jae-Yun (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Cho, Jae-Yong (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • 김민경 (연세대학교 의과대학 내과학교실, 강남세브란스병원) ;
  • 박지수 (연세대학교 의과대학 내과학교실, 강남세브란스병원) ;
  • 마대원 (연세대학교 의과대학 내과학교실, 강남세브란스병원) ;
  • 윤지영 (연세대학교 의과대학 내과학교실, 강남세브란스병원) ;
  • 임재윤 (연세대학교 의과대학 내과학교실, 강남세브란스병원) ;
  • 조재용 (연세대학교 의과대학 내과학교실, 강남세브란스병원)
  • Published : 2012.10.01

Abstract

Hafnia alvei is a Gram-negative rod that is rarely isolated from human specimens and is rarely pathogenic. It has been associated with gastroenteritis, pneumonia, urinary tract infection, bacteremia, and nosocomial wound infection, but extra-intestinal H. alvei infection is very rare. We present a case of biliary sepsis caused by H. alvei. A 42-year-old woman was admitted with abdominal pain and jaundice. She was diagnosed with metastatic cholangiocarcinoma and received conservative treatment. Six days later, hyperbilirubinemia and signs of sepsis developed and H. alvei was isolated from both the bile and blood. Despite treatment with antibiotics the organism was sensitive to (it was documented as susceptible to piperacillin/tazobactam and ciprofloxacin in sensitivity tests), the patient's condition grew worse. The antibiotics were switched to meropenem and the biliary sepsis was resolved.

Hafnia alvei는 조건혐기성 그람 음성균으로 병원성은 거의 없는 것으로 알려져 있고 대개는 위장관계의 감염을 일으킨다. 면역기능이 저하된 환자에서 주로 발생하는 것으로 보고되고 있고 대부분의 환자들이 악성 종양, 에이즈, 장기이식 환자 등 만성질환을 가진 환자들이며 국내에는 이 균에 의한 장외감염의 보고가 드물며 담도 패혈증은 아직 보고된 바가 없다. H. alvei에 의한 감염의 경우 적절한 항생제만 사용한다면 사망까지 이르는 경우는 드물다. 저자들은 복통과 혈변을 주소로 내원한 42세 담관암종 환자의 담즙과 혈액에서 H. alvei를 분리하였고 meropenem을 사용하여 균이 음전되는 것을 경험하였기에 이를 보고하는 바이다.

Keywords

References

  1. Jennis F, Mccarthy SW. Hafnia: an unusual cause of postoperative gram-negative bacteriae. Med J Aust 1967;1: 286-287.
  2. Albert MJ, Alam K. Hafnia alvei, a probable cause of diarrhea in humans. Infect Immun 1991;59:1507-1513.
  3. Gunthard H, Pennekamp A. Clinical significance of extraintestinal Hafnia alvei isolates from 61 patients and review of the literature. Clin Infect Dis 1996;22:1040-1045. https://doi.org/10.1093/clinids/22.6.1040
  4. Klapholz A, Lessnau KD, Huang B, Talavera W, Boyle JF. Hafnia alvei: respiratory tract isolates in a community hospital over a three-year period and a literature review. Chest 1994;105:1098-1100. https://doi.org/10.1378/chest.105.4.1098
  5. Ramos A, Damaso D. Extraintestinal infection due to Hafnia alvei. Eur J Clin Microbiol Infect Dis 2000;19:708-710. https://doi.org/10.1007/s100960000356
  6. Kim YJ, Ryu HJ, An CH, et al. Two cases of necrotizing pneumonia with parapneumonic effusion due to Hafnia alvei. Korean J Med 2005;69:840-845.
  7. Jung SK, Lee JS, Kim KA, et al. Spontaneous bacterial peritonitis caused by Hafnia alvei in a patient with liver cirrhosis. Infect Chemother 2010;42:420-423. https://doi.org/10.3947/ic.2010.42.6.420
  8. Barry JW, Dominguez EA, Boken DJ, Preheim LC. Hafnia alvei infection after liver transplantation. Clin Infect Dis 1997;24:1263-1264. https://doi.org/10.1093/clinids/24.6.1263
  9. Stock I, Rahman M, Sherwood KJ, Wiedemann B. Natural antimicrobial susceptibility patterns and biochemical identification of Escherichia albertii and Hafnia alvei strains. Diagn Microbiol Infect Dis 2005;51:151-163. https://doi.org/10.1016/j.diagmicrobio.2004.10.008
  10. Song W, Kim TK, Park MJ, Lee KM. A case of Hafnia alvei peritonitis with septicemia. Korean J Clin Microbiol 2001; 4:139-141.
  11. Ibanez Pérez de la Blanca MA, Cantalejo Santos FJ, Pasquau J. Hafnia alvei bacteremia in an AIDS patient. Med Clin (Barc) 1997;108:757-758.
  12. Savini V, Catavitello C, Di Bonaventura G, et al. VITEK 2 failure in screening Hafnia alvei inducible beta-lactam resistance. J Hosp Infect 2008;69:396-398. https://doi.org/10.1016/j.jhin.2008.03.017