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particularly in the left base&#46; Cysts of her underlying disease were palpated in the abdomen&#46;<br></br><br></br>Results of blood laboratory test son admission included&#58; Creatinine 1&#46;5 mg&#47;dL&#44; WBC 5090 &#40;82&#37; neutrophils&#41;&#44;<br></br>platelets 95&#44;000&#44; prothrombin activity 55&#37;&#46; Results of all other blood tests and urine analysis were normal&#46;<br></br><br></br>Chest X-rays showed blurring of left base&#44; and patient was admitted to hospital with a diagnosis of left basal pneumonia&#46;<br></br><br></br>After collecting samples for culture &#40;blood&#44; urine&#44; sputum&#41;&#44; empirical treatment was started with cefotaxime&#46;<br></br><br></br>At 24 hours of admission&#44; the patient experienced impairment of her general condition&#44; severe arterial hypotension&#44;<br></br>oliguria&#44; and coagulopathy&#44; requiring hemodynamic support with dopamine and colloids&#44; furosemide infusion&#44; and<br></br>vitamin K treatment&#46; A CT scan of the abdomen and pelvis found no added disease to cysts&#46;<br></br><br></br>Because of severity of the condition&#44; cefotaxime was replaced by imipenem and clarythromycin&#46; Blood culture results reported isolation of penicillin-resistant and imipenem-susceptible Hafnia alvei&#46;<br></br><br></br>Measures taken achieved clinical stability and improvement of the patient&#46; Immunosuppression&#44; necessary to<br></br>prevent rejection of transplanted organs&#44; implies a predisposition to experience severe infection&#46;1 Rubin et al<br></br>reported a calendar of infections depending on the transplant period&#58; hospital-acquired infections are common in the first month&#44; opportunistic infections predominate between the first and sixth months&#44; and any community-<br></br>acquired infection may occur after 6 months&#46;2<br></br><br></br>A community-acquired H&#46; alvei infection occurring in a kidney transplant patient 20 years after transplant is reported here&#46;<br></br><br></br>Members of the Hafnia genus are Gram-negative bacilli belonging to the family Enterobacteriaceae that occasionally<br></br>cause infection in humans&#46; Though this species has been known since 1954&#44; for decades it was considered to belong to the genus Enterobacter&#44; and was therefore called &#171;Enterobacter hafniae&#187; or &#171;Enterobacter alvei&#187;&#46; Recent DNA and biochemical studies defined these organisms as members of a separate genus with a single species&#44; Hafnia alvei&#46;3<br></br><br></br>The gastrointestinal tract of humans and animals&#44; particularly mammalians&#44; but also birds&#44; may be a reservoir for Hafnia&#46;3 Epidemics of H&#46; alvei infection related to the poultry industry are well documented in the literature&#46;4 In our case&#44; the patient was questioned again and said that she was in continuous contact with poultry&#44; but had no awareness that her animals were ill&#46;<br></br><br></br>Most patients colonized or infected by H&#46; alvei have underlying diseases such as cancer &#40;particularly hematological<br></br>tumors&#41;&#44; surgery&#44; trauma&#44; pulmonary disease&#44; cirrhosis&#44; hepatitis&#44; or pancreatitis&#46;5 In the case reported&#44; CRF for polycystic liver and kidney disease&#44; chronic virus C hepatitis&#44; and immunosuppression also existed&#46; In this patient&#44;<br></br>comorbid conditions and repeated contact with poultry may have promoted infection development&#46;<br></br><br></br>Very little is known about this microorganism as a pathogen in animals and humans&#46; It may cause a great variety of<br></br>systemic infections&#44; including septicemia and pneumonia&#46;<br></br><br></br>A literature review revealed that half the patients with bacteremia were immunocompromised because of tumors&#44;<br></br>hepatic disease&#44; or HIV infection&#46; 3 In transplant patients&#44; association was only found with liver6 and stem cell transplant&#46;7 Our case is the first reported in a kidney transplant patient&#46;<br></br><br></br>In conclusion&#44; immunosuppression associated to transplant and underlying diseases predispose to uncommon infections&#46; A first description of an H&#46; alvei infection in a kidney transplant patient whose main clinical manifestation<br></br>was septicemia is given&#46; </p>"
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        "resumen" => "La inmunosupresi&#243;n asociada al transplante conlleva un riesgo de padecer infecciones 1&#46; Mujer de 69 a&#241;os con antecedentes de IRC secundaria a enfermedad poliqu&#237;stica hepatorrenal del adulto&#44; en programa de HD desde 1982&#46; Recibi&#243; un injerto renal de cad&#225;ver en 1986&#46; La inmunosupresi&#243;n basal fue ciclosporina&#44; azatioprina&#44; y esteroides&#46; Otros antecedentes relevantes eran HTA&#44; hepatopat&#237;a cr&#243;nica por virus C y alergia a quinolonas&#46; "
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Sepsis induced by hafnia alvei in a kidney transplant patient
Sepsis por hafnia alvei en una paciente con trasplante renal
Manuel Herasa, Rosa Sáncheza, Maria José Fernández-Reyesa, Susana Hernandob
a Servicio de Nefrología Hospital General de Segovia Segovia, Segovia, España,
b Servicio de Microbiología, Hospital General de Segovia Segovia, Segovia, España,
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particularly in the left base&#46; Cysts of her underlying disease were palpated in the abdomen&#46;<br></br><br></br>Results of blood laboratory test son admission included&#58; Creatinine 1&#46;5 mg&#47;dL&#44; WBC 5090 &#40;82&#37; neutrophils&#41;&#44;<br></br>platelets 95&#44;000&#44; prothrombin activity 55&#37;&#46; Results of all other blood tests and urine analysis were normal&#46;<br></br><br></br>Chest X-rays showed blurring of left base&#44; and patient was admitted to hospital with a diagnosis of left basal pneumonia&#46;<br></br><br></br>After collecting samples for culture &#40;blood&#44; urine&#44; sputum&#41;&#44; empirical treatment was started with cefotaxime&#46;<br></br><br></br>At 24 hours of admission&#44; the patient experienced impairment of her general condition&#44; severe arterial hypotension&#44;<br></br>oliguria&#44; and coagulopathy&#44; requiring hemodynamic support with dopamine and colloids&#44; furosemide infusion&#44; and<br></br>vitamin K treatment&#46; A CT scan of the abdomen and pelvis found no added disease to cysts&#46;<br></br><br></br>Because of severity of the condition&#44; cefotaxime was replaced by imipenem and clarythromycin&#46; Blood culture results reported isolation of penicillin-resistant and imipenem-susceptible Hafnia alvei&#46;<br></br><br></br>Measures taken achieved clinical stability and improvement of the patient&#46; Immunosuppression&#44; necessary to<br></br>prevent rejection of transplanted organs&#44; implies a predisposition to experience severe infection&#46;1 Rubin et al<br></br>reported a calendar of infections depending on the transplant period&#58; hospital-acquired infections are common in the first month&#44; opportunistic infections predominate between the first and sixth months&#44; and any community-<br></br>acquired infection may occur after 6 months&#46;2<br></br><br></br>A community-acquired H&#46; alvei infection occurring in a kidney transplant patient 20 years after transplant is reported here&#46;<br></br><br></br>Members of the Hafnia genus are Gram-negative bacilli belonging to the family Enterobacteriaceae that occasionally<br></br>cause infection in humans&#46; Though this species has been known since 1954&#44; for decades it was considered to belong to the genus Enterobacter&#44; and was therefore called &#171;Enterobacter hafniae&#187; or &#171;Enterobacter alvei&#187;&#46; Recent DNA and biochemical studies defined these organisms as members of a separate genus with a single species&#44; Hafnia alvei&#46;3<br></br><br></br>The gastrointestinal tract of humans and animals&#44; particularly mammalians&#44; but also birds&#44; may be a reservoir for Hafnia&#46;3 Epidemics of H&#46; alvei infection related to the poultry industry are well documented in the literature&#46;4 In our case&#44; the patient was questioned again and said that she was in continuous contact with poultry&#44; but had no awareness that her animals were ill&#46;<br></br><br></br>Most patients colonized or infected by H&#46; alvei have underlying diseases such as cancer &#40;particularly hematological<br></br>tumors&#41;&#44; surgery&#44; trauma&#44; pulmonary disease&#44; cirrhosis&#44; hepatitis&#44; or pancreatitis&#46;5 In the case reported&#44; CRF for polycystic liver and kidney disease&#44; chronic virus C hepatitis&#44; and immunosuppression also existed&#46; In this patient&#44;<br></br>comorbid conditions and repeated contact with poultry may have promoted infection development&#46;<br></br><br></br>Very little is known about this microorganism as a pathogen in animals and humans&#46; It may cause a great variety of<br></br>systemic infections&#44; including septicemia and pneumonia&#46;<br></br><br></br>A literature review revealed that half the patients with bacteremia were immunocompromised because of tumors&#44;<br></br>hepatic disease&#44; or HIV infection&#46; 3 In transplant patients&#44; association was only found with liver6 and stem cell transplant&#46;7 Our case is the first reported in a kidney transplant patient&#46;<br></br><br></br>In conclusion&#44; immunosuppression associated to transplant and underlying diseases predispose to uncommon infections&#46; A first description of an H&#46; alvei infection in a kidney transplant patient whose main clinical manifestation<br></br>was septicemia is given&#46; </p>"
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ISSN: 20132514
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