Rasmussen Sofie Larsen, Ørsted Iben, Tarpgaard Irene Harder, Nielsen Hans Linde
Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.
Department of Infectious Diseases, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.
Gut Pathog. 2021 Apr 23;13(1):26. doi: 10.1186/s13099-021-00422-8.
Helicobacter cinaedi are motile, gram-negative spiral rods with a natural reservoir in the intestinal tract of hamsters and rhesus monkeys. In humans, H. cinaedi has been reported in different human infections like fever, abdominal pain, gastroenteritis, proctitis, diarrhoea, erysipelas, cellulitis, arthritis, and neonatal meningitis typically diagnosed by positive blood cultures. Even though H. cinaedi has been detected from human blood and stool the entry of H. cinaedi into the blood stream was undocumented until quite recently. The use of pulse-field gel electrophoresis (PFGE) demonstrated that stool- and blood-derived H. cinaedi strains were consistent.
Here, we describe a rare Danish case of H. cinaedi bacteraemia in an immunocompetent 44-year-old male with diarrhoea. We isolated H. cinaedi from a blood culture taken at admission, and from a FecalSwab taken at day six despite ongoing antibiotic therapy. Next, we made a genetic comparison of both isolates by use of Multi-locus sequence typing (MLST)- and Single nucleotide polymorphism (SNP)-analysis. The two isolates were identical with zero SNPs and by use of MLST the isolate was identified as a novel ST20, confirming previous data of the intestinal tract as a route of H. cinaedi bacteraemia. The results of our AST showed a resistance pattern with higher MICs for ciprofloxacin and clarithromycin than for ampicillin, amoxicillin, gentamicin, and imipenem. The patient was cured with targeted therapy with pivampicillin; however, the primary source of transmission was unknown.
In conclusion, this case of H. cinaedi bacteraemia secondary to enterocolitis in an immunocompetent patient provide clear evidence that one route of infection occurs through translocation from the intestinal tract to the bloodstream. Helicobacter cinaedi from blood and faeces were identical with a novel ST20, resistant to ciprofloxacin and clarithromycin however, the patient was cured with oral pivampicillin.
嗜人埃希菌是运动性革兰氏阴性螺旋杆菌，在仓鼠和恒河猴的肠道中有天然储存宿主。在人类中，嗜人埃希菌已在不同的人类感染中被报道，如发热、腹痛、肠胃炎、直肠炎、腹泻、丹毒、蜂窝织炎、关节炎和新生儿脑膜炎，通常通过血培养阳性来诊断。尽管已从人类血液和粪便中检测到嗜人埃希菌，但直到最近，嗜人埃希菌进入血流的情况仍未得到证实。脉冲场凝胶电泳（PFGE）的应用表明，来自粪便和血液的嗜人埃希菌菌株是一致的。
在此，我们描述了丹麦一例罕见的嗜人埃希菌败血症病例，患者为一名44岁免疫功能正常的男性，伴有腹泻。我们从入院时采集的血培养物以及尽管正在进行抗生素治疗但在第6天采集的粪便拭子中分离出嗜人埃希菌。接下来，我们通过多位点序列分型（MLST）和单核苷酸多态性（SNP）分析对这两个分离株进行了基因比较。这两个分离株完全相同，SNP为零，通过MLST分析，该分离株被鉴定为新的ST20，证实了先前关于肠道是嗜人埃希菌败血症途径的数据。我们的药敏试验结果显示，与氨苄西林、阿莫西林、庆大霉素和亚胺培南相比，环丙沙星和克拉霉素的最低抑菌浓度（MIC）更高，呈现出耐药模式。患者接受了匹氨西林靶向治疗后治愈；然而，主要传播源尚不清楚。
总之，该例免疫功能正常患者因小肠结肠炎继发嗜人埃希菌败血症的病例提供了明确证据，表明一种感染途径是通过从肠道转移至血流。血液和粪便中的嗜人埃希菌与新的ST20相同，对环丙沙星和克拉霉素耐药，不过患者通过口服匹氨西林治愈。
