Lück Paul Christian, Schneider Thomas, Wagner Jutta, Walther Ilona, Reif Ursula, Weber Stefan, Weist Klaus
Institut für Medizinische Mikrobiologie und Hygiene, TU Dresden, Fiedlerstrasse 42, D-01307 Dresden, Germany.
Medizinische Klinik I (Gastroenterologie, Rheumatologie und Infektiologie), Charité -Universitätsmedizin Berlin Hindenburgdamm 30, 12203 Berlin, Germany.
J Med Microbiol. 2008 Feb;57(Pt 2):240-243. doi: 10.1099/jmm.0.47382-0.
We describe the case of a 66-year-old man with a culture-proven Legionella pneumonia after kidney transplantation. The patient developed the infection 15 days after discharge from a university hospital. Legionella pneumonia caused by Legionella pneumophila serogroup 5/10 was established by positive direct fluorescence assay, positive urinary-antigen detection and isolation of the causative agent. The infection was successfully treated by giving appropriate antibiotics, but the further course was complicated by invasive aspergillosis, cytomegalovirus pneumonia, failure of the transplanted kidney and development of septic anaemia. Four months after the diagnosis of Legionella pneumonia the patient died of multi-organ failure. The microbiological and epidemiological investigation revealed that strains from the water supply of the patient's private home were indistinguishable from the patient's isolate by amplified fragment length polymorphism analysis and sequence-based typing (SBT). Unrelated strains of serogroups 4, 5, 8 and 10 from the Dresden strain collection were of different SBT types. Thus, SBT is a very useful tool for epidemiological investigation of infections by L. pneumophila serogroups other than serogroup 1.
我们描述了一例66岁男性肾移植后经培养证实的嗜肺军团菌肺炎病例。该患者在大学医院出院15天后发生感染。通过直接荧光检测阳性、尿抗原检测阳性以及病原体分离,确诊为由嗜肺军团菌血清型5/10引起的军团菌肺炎。给予适当抗生素后感染得到成功治疗,但后续病程因侵袭性曲霉病、巨细胞病毒肺炎、移植肾衰竭和脓毒性贫血而复杂化。在诊断军团菌肺炎四个月后,患者死于多器官功能衰竭。微生物学和流行病学调查显示,通过扩增片段长度多态性分析和基于序列的分型(SBT),患者家中供水系统分离出的菌株与患者分离株无法区分。德累斯顿菌株库中血清型4、5、8和10的无关菌株具有不同的SBT类型。因此,SBT是对血清型1以外的嗜肺军团菌血清型感染进行流行病学调查的非常有用的工具。