Nursing School of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900 - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
Infection Control Comission, Clinics Hospital, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, s/n - Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil.
BMC Infect Dis. 2018 Nov 3;18(1):547. doi: 10.1186/s12879-018-3452-7.
The Leuconostoc mesenteroides are members of the Streptococcae family and currently has been recognized as potential pathogens. This case describes a bacteremia caused by L. mesenteroides in an immunocompetent patient affected by Chagas disease.
A 67-year-old female patient with chagasic megaesophagus and megacolon was submitted to a Heller myotomy for achalasia in 2000 and endoscopic dilatation in 2015. Patient was admitted to the Nutrology Ward in May 2016 with protein-calorie malnutrition associated with achalasia and receiving enteral nutrition. In July 2016, the patient underwent a Serra-Doria surgery. In the third postoperative day she presented an important abdominal distension. She was submitted to a new surgical intervention, and then a terminal ileum perforation was detected, leading the surgeon to perform an enterectomy with side-to-side anastomosis. The next day after the surgery (4th postoperative day) the patient presented a decreased level of consciousness (Glasgow coma scale = 8), hypotension and hypoxemia. In two samples of blood cultures there was growth of Leuconostoc mesenteroides. Susceptibility pattern was evaluated by the diffusion disk method. The microorganism was susceptible to penicillin, ampicillin, chloramphenicol, erythromycin, and fluoroquinolones, but resistant to rifampin, tetracycline, vancomycin and teicoplanin.
We concluded that infections caused by L. mesenteroides is serious and should be considered not only in settings of immunosuppression and prolonged antimicrobial use, but also in immunocompetent patients undergoing surgeries involving the gastrointestinal tract.
肠膜明串珠菌属于链球菌科，目前已被认为是一种潜在的病原体。本病例描述了一例免疫功能正常的恰加斯病患者发生肠膜明串珠菌菌血症。
一位 67 岁女性患者患有恰加斯病性巨食管和巨结肠，于 2000 年接受了 Heller 肌切开术治疗贲门失弛缓症，于 2015 年接受了内镜扩张术。患者于 2016 年 5 月因贲门失弛缓症导致的蛋白能量营养不良而入住营养科，并接受肠内营养。2016 年 7 月，患者接受了 Serra-Doria 手术。术后第 3 天，患者出现明显的腹胀。患者再次接受手术治疗，随后发现末端回肠穿孔，导致外科医生进行了侧侧吻合的回肠切除术。手术后的第二天（术后第 4 天），患者出现意识水平下降（格拉斯哥昏迷量表评分为 8 分）、低血压和低氧血症。两份血培养样本中均生长出肠膜明串珠菌。采用扩散盘法评估药敏模式。该微生物对青霉素、氨苄西林、氯霉素、红霉素和氟喹诺酮类药物敏感，但对利福平、四环素、万古霉素和替考拉宁耐药。
我们得出结论，肠膜明串珠菌感染很严重，不仅应在免疫抑制和长期使用抗菌药物的情况下考虑，也应在接受涉及胃肠道的手术的免疫功能正常的患者中考虑。
