Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Community-acquired Extended-spectrum and Plasmid-mediated ampC Beta-lactamase-producing Multidrug-resistant Enterobacter cloacae Septicaemia in a Cat with Euthyroid Sick Syndrome

정상 갑상샘 질환 증후군 고양이의 지역사회획득 광범위 및 플라스미드 유래 ampC beta-lactamase 양성 다약제내성 Enterobacter cloacae 패혈증

  • Han, Jae-Ik (Veterinary Laboratory Medicine, College of Veterinary Medicine, Chungbuk National University) ;
  • Na, Ki-Jeong (Veterinary Laboratory Medicine, College of Veterinary Medicine, Chungbuk National University)
  • Accepted : 2015.04.22
  • Published : 2015.04.30
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Abstract

A 7-year-old castrated male Korean Shorthair cat was referred with lethargy and anorexia. Laboratory examination revealed moderate degenerative changes of peripheral neutrophils on blood smear examination and decreased levels of free and total thyroxine ($T_4$) as well as bacterial growth on blood culture. Molecular analyses of the 16S ribosomal RNA gene and heat shock protein 60 gene confirmed the bacterium as Enterobacter cloacae. A minimal inhibitory concentration test showed multidrug resistance of the bacterium against 16 antibiotics. Polymerase chain reaction (PCR) and subsequent sequencing specifically for $bla_{TEM}$, $bla_{SHV}$, $bla_{CTX-M}$, and plasmid-mediated ampC genes revealed positive results to $bla_{TEM-1}$, $bla_{CTX-M-15}$, and plasmid-mediated $bla_{ACT-1}$ genes, indicating that the isolated bacterium contains plasmids containing genes encoding extended-spectrum beta-lactamase and plasmid-mediated ampC beta-lactamase. After 1 month of treatment with antibiotics and levothyroxine, the cat's condition improved; both the thyroid function test and the blood culture showed no abnormalities. This is the first report of community-acquired multidrug-resistant E. cloacae-induced euthyroid sick syndrome in a cat. By the prompt diagnostic procedures and properly selected antibiotic therapy, the cat was recovered from the multidrug-resistant bacterium-induced septicaemia.

7년령, 중성화 수컷 고양이가 무기력과 식욕부진으로 내원하였다. 실험실 검사는 말초혈액 호중구에서 중등도의 퇴행성 변화, free 및 total thyroxine의 농도 감소 및 혈액배양에서 세균증식이 관찰되었다. 16S ribosomal RNA 및 heat shock protein 60 유전자 검사 결과 세균은 Enterobacter cloacae로 확인되었다. 항생제 최소억제농도 평가결과 16개 항생제에 대한 다약제 내성이 관찰되었다. 중합효소연쇄반응 및 시퀀싱 결과 $bla_{TEM-1}$, $bla_{CTX-M-15}$ 및 플라스미드 유래 $bla_{ACT-1}$ 유전자에 대한 양성 반응이 관찰되었으며, 결과적으로 확인된 세균이 광범위 beta-lactamase 및 ampC beta-lactamase를 합성하는 플라스미드를 보유한 것을 확인하였다. 환자는 1개월 간 항생제와 levothyroxine 치료를 받은 후 증상이 호전되었고, 치료 후 갑상선 기능검사와 혈액배양 결과 이상소견은 소실되었다. 이 증례는 고양이의 지역사회획득 다약제내성 E. cloacae에 의한 정상 갑상샘 질환 증후군의 첫 예이다. 신속한 진단과정과 적절한 항생제 선택에 의해 이환된 고양이는 패혈증으로부터 회복되었다.

Keywords

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