Beatty Norman, Brown Craig, Zangeneh Tirdad, Al Mohajer Mayar
Department of Medicine, Division of Infectious Diseases, University of Arizona College of Medicine, Tucson, Arizona, USA.
Department of Medicine, Baylor College of Medicine,Division of Infectious Diseases, Houston, Texas, USA.
BMJ Case Rep. 2017 Jun 13;2017:bcr-2017-219618. doi: 10.1136/bcr-2017-219618.
A 56-year-old man with a history of injection drug use and two prior episodes of native valve infective endocarditis presented with dyspnoea on exertion. Our preliminary work-up revealed bacteraemia with reported growth of ' group' on multiple blood cultures. The patient was later found to have eustachian valve and prosthetic pulmonic valve endocarditis. Initially, he responded to standard antimycobacterial therapy for rapidly growing mycobacteria (RGM) with supporting laboratory susceptibilities. However, he later developed refractory disease and persistent bacteraemia in the setting of these alleged susceptible antibiotics. Further molecular testing revealed a functional and inducible 41) gene which confers macrolide resistance. A subspecies analysis of the group revealed the subspecies to be We present a challenging case of subsp. bacteraemia and prosthetic valve endocarditis with further discussion on treatment and management of this infection along with the taxonomic complexity of this ubiquitous RGM.
一名56岁男性，有注射吸毒史，曾两次发生自体瓣膜感染性心内膜炎，此次因劳力性呼吸困难就诊。我们的初步检查发现菌血症，多次血培养报告有“菌群”生长。该患者后来被发现患有咽鼓管瓣膜和人工肺动脉瓣心内膜炎。起初，他对针对快速生长分枝杆菌（RGM）的标准抗分枝杆菌治疗有反应，实验室药敏结果支持该治疗。然而，在使用这些所谓敏感抗生素的情况下，他后来出现了难治性疾病和持续性菌血症。进一步的分子检测发现了一个功能性且可诱导的41）基因，该基因赋予大环内酯类耐药性。对该菌群的亚种分析显示该亚种为。我们报告了一例具有挑战性的亚种菌血症和人工瓣膜心内膜炎病例，并进一步讨论了这种感染的治疗和管理，以及这种普遍存在的RGM的分类复杂性。
