Corynebacterium pseudodiphtheriticum:: An easily missed respiratory pathogen in HIV-infected patients
Corynebacterium pseudodiphtheriticum:: An easily missed respiratory pathogen in HIV-infected patients
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DOI：
10.1016/s0732-8893(98)00163-1
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发表时间：
1999-04-01
影响因子：
2.9
通讯作者：
Martin-Hidalgo, A
中科院分区：
文献类型：
--
作者：
Gutíerrez-Rodero, F;de la Tabla, VO;Martin-Hidalgo, A
尽管假白喉棒状杆菌是免疫低下患者的一种众所周知的呼吸道病原体，但据报道，假白喉棒杆菌发生在可归因于艾滋病毒感染的人身上的情况并不常见。我们报告了三例可归因于HIV感染患者的假白喉杆菌引起的呼吸道感染，并回顾了以前的四例医学文献。他们都是男性，CD4淋巴细胞计数的中位数为110个/mm(3)(范围为18-198个/mm(3))；7例中有5例发生在以前诊断为艾滋病的人中。首发症状通常是急性的，最常见的X线表现是肺泡浸润性(6例)伴空洞(2例)和胸腔积液(2例)。在7例患者中，5例从支气管镜标本中分离到假白喉杆菌，其余2例从肺活检(1例)和痰(1例)中检出假白喉杆菌。在本文报告的三名患者和之前医学文献中的一例中，通过支气管肺泡灌洗或有保护的刷状导管操作获得的支气管镜样本的定量培养产生了超过10(3)cfu/ml。所有测试菌株对青霉素和万古霉素敏感。对大环内酯类抗生素的耐药性很常见。7名患者中有6名康复。在HIV感染者中，假白喉杆菌应被视为一种潜在的呼吸道病原体。这种感染出现在艾滋病毒病程的后期，在大多数病例中，它似乎对适当的抗生素治疗有良好的反应。这种容易被忽视的病原体应该被添加到与该人群呼吸道感染有关的微生物名单中。(C)1999年爱思唯尔科学公司。
Despite being a well-known respiratory pathogen for immuno-compromised patients, Corynebacterium pseudodiphtheriticum has uncommonly been reported to occur in persons with infection attributable to HIV virus. We report three cases of respiratory tract infection attributable to C. pseudodiphtheriticum in HIV-infected patients and review the four previous cases from the medical literature. All of them were male with a median CD4 lymphocyte count of 110 cells/mm(3) (range, 18-198/mm(3)); five of the seven cases occurred in persons for whom AIDS was diagnosed previously. The onset of symptom atology was usually acute and the most common radiographic appearance was alveolar infiltrate (six patients) with cavitation (two patients) and pleural effusion (two patients). In five of the seven cases, C. pseudodiphtheriticum was isolated from bronchoscopic samples and in the remaining two cases was recovered from lung biopsy (one patient) and sputum (one patient). In the three patients reported herein and in one previous case from the medical literature, quantitative culturing of bronchoscopic samples obtained through either bronchoalveolar lavage or protected brush catheter procedures yielded more than 10(3) CFU/mL. All the strains tested were susceptible to penicillin and vancomycin. Resistance to macrolides was common. Recovery was observed in six of the seven patients. C. pseudodiphtheriticum should be regarded as a potential respiratory pathogen in HIV-infected patients. This infection presents late in the course of HIV disease and it seems to respond well to appropriate antibiotic treatment in most of the cases. This easily overlooked pathogen should be added to the list of organisms implicated in respiratory tract infections in this population. (C) 1999 Elsevier Science Inc.