Shim Hyoeun Eun, Sung Heungsup, Baek Seung Mi, Namgung Seung, Kim Mi-Na, Kim Yong Gyun, Lee Gyu Hyung
Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Korean J Lab Med. 2009 Feb;29(1):41-7. doi: 10.3343/kjlm.2009.29.1.41.
Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, urease-positive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.
肺冢村菌是一种需氧放线菌。我们报告了一例与导管相关的肺冢村菌菌血症病例。一名39岁的急性淋巴细胞白血病男性患者住院接受骨髓移植(BMT)。患者在住院第7天(HD)出现高热,经万古霉素治疗后体温下降,于住院第9天接受了BMT。尽管持续使用万古霉素、美罗培南和两性霉素B治疗,但患者在住院第16天再次发热,不过在拔除Hickman导管(HC)后,于住院第19天体温恢复正常。在住院第7天、第16天和第19天采集了三组血培养样本,其中一组来自HC,两组来自静脉穿刺,同时还对HC的远端尖端进行了培养。在住院第19天采集的所有3份从HC抽取的血培养样本的需氧瓶、一份外周血培养样本以及HC尖端培养物中,均生长出细长、直的革兰氏阳性杆菌,改良金胺O染色呈阳性。该菌在培养3天后形成微小、粗糙、灰色的菌落,延长培养时间后可生长为大的扁平菌落。它过氧化氢酶阳性、尿素酶阳性,在三糖铁琼脂上呈碱性斜面/碱性底层,能水解次黄嘌呤。该菌16S rRNA的1296个碱基对序列与已发表的肺冢村菌DSM 44142T序列具有100.0%的同源性。据我们所知,这是韩国首例肺冢村菌菌血症的报告。