Tanyel Esra, Taşdelen Fişgin Nuriye, Esen Saban, Darka Ozge, Bahçivan Muzaffer, Leblebicioğlu Hakan, Tülek Necla
Ondokuz Mayis Universitesi Tip Fakültesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Anabilim Dali, Samsun.
Mikrobiyol Bul. 2009 Oct;43(4):667-70.
Moraxella catarrhalis is a gram-negative, catalase and oxidase positive diplococcus. While it causes otitis media, sinusitis, bronchitis and conjunctivitis in children and adults, it has a tendency to cause lower respiratory tract infections in older ages. More severe clinical pictures with the range of sepsis to endocarditis are also seen in immunocompromised patients. In this report, a case of M. catarrhalis endocarditis in an immunocompetent host who needed valve replacement has been presented. Forty three years old female patient was admitted to our hospital with the complaints of fever, nausea, night sweating and arthralgia for 20 days. Physical examination revealed systolic murmurs on the apex, and vegetation on the atrial surface of mitral valve was detected by transthoracic echocardiography. Intravenous (IV) ampicillin (4 x 3 g/day) and gentamicin (3 x 80 mg/day) treatment was started empirically with prediagnosis of infective endocarditis. The treatment was modified to IV ceftriaxone (1 x 2 g/day) and gentamicin (3 x 80 mg/day) due to the reporting of gram-negative bacilli in blood culture (BacT/ALERT 3D, bioMérieux, France) on the next day. Gram-negative cocobacilli/diplococci were detected with Gram stain on the smear prepared from the blood culture bottle. Simultaneous subcultures to blood agar and eosin methylene blue agar yielded white colored, S-type, non-hemolytic colonies on only blood agar. Catalase and oxidase tests were positive, while beta-lactamase activity was negative. The isolate was identified as M. catarrhalis by using API NH (bioMérieux, France) identification strips. M. catarrhalis was isolated from five different blood culture specimens of the patient. The focus for bacteremia could not be detected. The patient underwent mitral valve replacement operation as an emergency since the vegetation exhibited rapid growth on the fifth day of medical treatment. Antibacterial therapy was completed for 6 weeks. Control echocardiography revealed that artificial mitral valve was open and functional, thus the patient recovered completely without sequela. In conclusion, M. catarrhalis should be considered as a possible cause of infective endocarditis even in immunocompetent patients.
卡他莫拉菌是一种革兰氏阴性、过氧化氢酶和氧化酶阳性的双球菌。它可导致儿童和成人患中耳炎、鼻窦炎、支气管炎和结膜炎，在老年人中更易引发下呼吸道感染。免疫功能低下的患者还会出现从败血症到心内膜炎等更严重的临床表现。在本报告中，介绍了一例免疫功能正常的宿主发生卡他莫拉菌性心内膜炎且需要进行瓣膜置换的病例。一名43岁女性患者因发热、恶心、盗汗和关节痛20天入院。体格检查发现心尖部有收缩期杂音，经胸超声心动图检测发现二尖瓣心房面有赘生物。在初步诊断为感染性心内膜炎后，经验性地开始静脉注射氨苄西林（4×3g/天）和庆大霉素（3×80mg/天）治疗。次日，由于血培养（法国生物梅里埃公司的BacT/ALERT 3D）报告革兰氏阴性杆菌，治疗改为静脉注射头孢曲松（1×2g/天）和庆大霉素（3×80mg/天）。从血培养瓶制备的涂片经革兰氏染色检测到革兰氏阴性球杆菌/双球菌。同时接种血琼脂和伊红美蓝琼脂，仅在血琼脂上长出白色、S型、非溶血性菌落。过氧化氢酶和氧化酶试验呈阳性，而β-内酰胺酶活性为阴性。使用法国生物梅里埃公司的API NH鉴定条将分离株鉴定为卡他莫拉菌。从该患者的五个不同血培养标本中分离出卡他莫拉菌。未检测到菌血症的病灶。由于治疗第5天赘生物生长迅速，患者作为急诊接受了二尖瓣置换手术。抗菌治疗持续6周。对照超声心动图显示人工二尖瓣开放且功能正常，因此患者完全康复，无后遗症。总之，即使在免疫功能正常的患者中，卡他莫拉菌也应被视为感染性心内膜炎的可能病因。
