Department of Microbiology, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, Brazil.
Int J Infect Dis. 2010 Apr;14(4):e344-7. doi: 10.1016/j.ijid.2009.04.016. Epub 2009 Aug 4.
Balanoposthitis is defined as the inflammation of the glans penis and its foreskin. In the presence of other underlying medical conditions, this localized infection may spread systemically, serving as a source of fever and bacteremia in neutropenic males. Two rare cases of balanoposthitis caused by a clonally related Pseudomonas aeruginosa isolate co-producing the SPM-1 metallo-beta-lactamase and the novel 16S rRNA methylase RmtD are described. Four multidrug-resistant (MDR) P. aeruginosa isolates were successively recovered from glans/foreskin swabs and urine cultures from two uncircumcised pediatric patients, one with Burkitt's non-Hodgkin's lymphoma and one with acute lymphoblastic leukemia. Clinically, preputial colonization by MDR P. aeruginosa evolved to severe balanoposthitis with glans/foreskin lesions as a source of fever. Combination therapy of ciprofloxacin and/or aztreonam (systemic) plus polymyxin B (topical) was effective once reversion of the neutropenic condition was achieved. Although P. aeruginosa remains an unusual cause of balanoposthitis, these cases should alert the physician to the potential pathogenicity of this bacterium. Furthermore, co-production of metallo-beta-lactamase and 16S rRNA methylase has a potential impact on the empirical management of complicated infections caused by P. aeruginosa.
龟头炎是指阴茎头部和包皮的炎症。在存在其他潜在疾病的情况下，这种局部感染可能会全身扩散，成为中性粒细胞减少男性发热和菌血症的源头。本文描述了两例罕见的由克隆相关铜绿假单胞菌分离株引起的龟头炎病例，这些分离株同时产生 SPM-1 金属β-内酰胺酶和新型 16S rRNA 甲基化酶 RmtD。先后从两名未行包皮环切术的儿科患者的龟头/包皮拭子和尿液培养物中成功分离出 4 株多药耐药（MDR）铜绿假单胞菌。这两名患者分别患有 Burkitt 非霍奇金淋巴瘤和急性淋巴细胞白血病。临床上，MDR 铜绿假单胞菌在包皮的定植发展为严重的龟头炎，龟头/包皮病变成为发热的源头。一旦中性粒细胞减少症的情况得到逆转，环丙沙星和/或氨曲南（全身）加多粘菌素 B（局部）的联合治疗是有效的。虽然铜绿假单胞菌仍然是龟头炎的一种不常见原因，但这些病例应引起医生对该细菌潜在致病性的注意。此外，金属β-内酰胺酶和 16S rRNA 甲基化酶的共同产生对铜绿假单胞菌引起的复杂感染的经验性治疗有潜在影响。
