Pan Wensen, Zhao Zhiming, Dong Mei
Department of Reproductive Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, China.
J Med Case Rep. 2011 Aug 15;5:377. doi: 10.1186/1752-1947-5-377.
Ralstonia pickettii is a gram-negative, oxidase-positive bacillus and is an emerging pathogen found in infections described in hospital settings. The cases reported in the literature mostly are nosocomial infections due to contaminated blood products, sterile water, saline, treatment fluids and venous catheters. Human infection unrelated to contaminated solutions is rare. We report a case of lobar pneumonia and pulmonary abscess caused by Ralstonia pickettii in an older patient.
A sixty-five-year old Han Chinese man presented having had cough, expectoration, chest pain and fever lasting for twenty days. His medical history was notable for hypertension over the previous ten years, and the habit of smoking for forty years. A thoracic computed tomography scan supported the diagnosis of right-sided lobar pneumonia. A lung biopsy was done and pathological analysis confirmed lobar pneumonia. Two lung biopsy specimens from separate sites grew Ralstonia pickettii. After six days, a repeat thoracic scan revealed a right-sided abscess. A thoracentesis was performed and the purulent fluid grew Ralstonia pickettii. The chest tube remained inserted to rinse the cavity with sterile sodium chloride. He received an antibiotic course of intravenous cefoperazone sodium-sulbactam sodium for eighteen days and imipenem-cilastatin for twelve days. A repeat chest X-ray revealed resolution of the pulmonary abscess and improvement of pneumonia. He remained afebrile and free of respiratory symptoms after treatments.
This case demonstrates a Ralstonia pickettii infection in the absence of an obvious nosocomial source. It is possible that such cases will become common in the future. Therefore, further studies are needed to evaluate its sensitivity to common antibiotics.
皮氏罗尔斯顿菌是一种革兰氏阴性、氧化酶阳性的杆菌，是医院环境中感染病例中发现的一种新兴病原体。文献报道的病例大多是因血液制品、无菌水、生理盐水、治疗液和静脉导管污染引起的医院感染。与污染溶液无关的人类感染很少见。我们报告一例老年患者由皮氏罗尔斯顿菌引起的大叶性肺炎和肺脓肿病例。
一名65岁的汉族男性，出现咳嗽、咳痰、胸痛和发热症状持续20天。他有高血压病史10年，吸烟习惯40年。胸部计算机断层扫描支持右侧大叶性肺炎的诊断。进行了肺活检，病理分析证实为大叶性肺炎。来自不同部位的两份肺活检标本培养出皮氏罗尔斯顿菌。6天后，重复胸部扫描显示右侧脓肿。进行了胸腔穿刺，脓性液体培养出皮氏罗尔斯顿菌。胸腔引流管一直留置，用无菌氯化钠冲洗胸腔。他接受了18天的静脉注射头孢哌酮钠舒巴坦钠和12天的亚胺培南西司他丁抗生素治疗。重复胸部X线检查显示肺脓肿消退，肺炎改善。治疗后他仍无发热，无呼吸道症状。
本病例显示了在无明显医院感染源情况下的皮氏罗尔斯顿菌感染。未来这类病例可能会变得常见。因此，需要进一步研究评估其对常用抗生素的敏感性。
