Medical Education Department, Taipei Medical University Hospital, Taipei, Taiwan.
Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
BMC Infect Dis. 2021 Sep 23;21(1):998. doi: 10.1186/s12879-021-06703-6.
Actinomyces odontolyticus is not commonly recognized as a causative microbe of liver abscess. The detection and identification of A. odontolyticus in laboratories and its recognition as a pathogen in clinical settings can be challenging. However, in the past decades, knowledge on the clinical relevance of A. odontolyticus is gradually increasing. A. odontolyticus is the dominant oropharyngeal flora observed during infancy [Li et al. in Biomed Res Int 2018:3820215, 2018]. Herein we report a case of severe infection caused by A. odontolyticus in an immunocompromised patient with disruption of the gastrointestinal (GI) mucosa.
We present a unique case of a patient with human immunodeficiency virus infection who was admitted due to liver abscess and was subsequently diagnosed as having coinfection of A. odontolyticus, Streptococcus constellatus, and Candida albicans during the hospital course. The empirical antibiotics metronidazole and ceftriaxone were replaced with the intravenous administration of fluconazole and ampicillin. However, the patient's condition deteriorated, and he died 3 weeks later.
This report is one of the first to highlight GI tract perforation and its clinical relevance with A. odontolyticus infection. A. odontolyticus infection should be diagnosed early in high-risk patients, and increased attention should be paid to commensal flora infection in immunocompromised individuals.
龋齿放线菌通常不被认为是肝脓肿的致病微生物。在实验室中检测和鉴定龋齿放线菌及其在临床环境中被认作病原体具有挑战性。然而，在过去几十年中，人们对龋齿放线菌的临床相关性的认识逐渐增加。龋齿放线菌是婴儿期观察到的主要口腔菌群[Li 等人，2018 年《生物医学研究国际》：3820215]。在此，我们报告了一例免疫功能低下患者因胃肠道（GI）黏膜受损而发生严重龋齿放线菌感染的病例。
我们报告了一例独特的人类免疫缺陷病毒感染患者病例，该患者因肝脓肿入院，随后在住院期间被诊断为同时感染了龋齿放线菌、星座链球菌和白色念珠菌。经验性抗生素甲硝唑和头孢曲松被氟康唑和氨苄西林的静脉给药所取代。然而，患者的病情恶化，3 周后死亡。
本报告首次强调了 GI 道穿孔及其与龋齿放线菌感染的临床相关性。在高危患者中应早期诊断龋齿放线菌感染，并应更加关注免疫功能低下个体共生菌群感染。
