Nadir bir etken: Rhodococcus equi, immünkompetan hastalarda yumuşak doku enfeksiyonlarına ilişkin bir vaka sunumu ve literatür incelemesi

Year 2023, , 235 - 241, 23.05.2023

Halime Araz , Aliye Bastug , İpek Mumcuoğlu , Esragül Akınci , Hurrem Bodur

https://doi.org/10.21673/anadoluklin.1168458

Abstract

Rhodococcus equi (R. equi) ilk olarak atlarda tanımlanan ve daha sonra bağışıklığı baskılanmış hastalarda fırsatçı enfeksiyonlara neden olduğu anlaşılan bir mikroorganizmadır. Özellikle bağışıklığı baskılanmış hastalarda akciğer enfeksiyonlarına neden olurken nadiren septik artrit ve yumuşak doku enfeksiyonları gibi hastalıklara neden olur. Hastalığın tanısı için epidemiyolojik risk faktörlerinin sorgulanması önemlidir. Klinisyen-mikrobiyolog ilişkisi de mikroorganizmanın laboratuvar tanısında önemlidir çünkü normal floranın veya kontaminantın bir parçası olarak gözden kaçabilir veya benzer fenotipik özelliklere sahip mikroorganizmalarla (Nocardia türleri veya hızla büyüyen mikobakteriler) karıştırılabilir. Nadiren de olsa bizim olgumuzda olduğu gibi immunkompetan hastalarda da bildirilmeye başlanmıştır. MEDLINE, SCOPUS, Google Akademik ve Cochrane aramaları, 1945’ten Temmuz 2021’e kadar Rhodococcus equi ve Corynebacterium equi anahtar kelimeleri kullanılarak yapıldı. Toplam 582 makale belirlendi. Bu anahtar kelimeleri içeren makaleler daha sonra “insan”, “yumuşak doku enfeksiyonları” ve “selülit” kelimeleri için tarandı ve sonunda toplam 42 makale listelendi. Literatürde R. equi ile ilgili bağışıklığı sağlam hastalarda yumuşak doku enfeksiyonu/selülit ile ilgili toplam 14 vaka raporu tespit edilmiştir. Bizim olgumuzda yumuşak doku enfeksiyonu mevcuttu ve apse kültüründe R. equi saptandı. Enfeksiyonların tedavisinde kültür alınması ve etkenin belirlenmesi çok önemlidir. Bu raporda, bağışıklık sistemi sağlam hastalarda R. equi’nin neden olduğu yumuşak doku enfeksiyonları gözden geçirilmiştir.

Keywords

Bağışıklık yeterliliği, insan, Rhodococcus equi, yumuşak doku enfeksiyonları

Supporting Institution

Herhangi bir destek yoktur.

A rare infectious agent: Rhodococcus equi, a case report and literature review of soft tissue infections in immunocompetent patients

Abstract

Rhodococcus equi (R. equi) is a microorganism that was first identified in horses. Afterward, it was found to cause opportunistic infections in immunosuppressed patients. It causes especially pulmonary infections in immunocompromised patients while it rarely causes diseases such as septic arthritis and soft tissue infections. It is important to question epidemiological risk factors for the diagnosis of the disease. Also, the clinician-microbiologist relationship is important in the laboratory diagnosis of the microorganism because it is possible to be missed as part of normal flora or contaminant or to be confused with microorganisms with similar phenotypic features (Nocardia species or rapidly growing mycobacteria). Rarely, it has been reported in immunocompetent patients, as in our case. MEDLINE, SCOPUS, Google Scholar, and Cochrane searches were performed using the keywords Rhodococcus equi and Corynebacterium equi from 1945 to July 2021. A total of 582 articles were determined. Articles containing these keywords were then scanned for the words “humans”, “soft tissue infections”, and “cellulite” and a total of 42 articles were listed in the end. A total of 14 case reports of soft tissue infection/cellulitis in immunocompetent patients related to R. equi were detected in the literature. In our case, there was a soft tissue infection and R. equi was detected in the abscess culture. Obtaining culture and determining the factor is very important in the treatment of infections. In this report, soft tissue infections caused by R. equi in immunocompetent patients are reviewed.

Keywords

Immunocompetence, human, Rhodococcus equi, soft tissue infections

References

• Magnusson H. Specific infectious pneumonia in the foal. A new pus pathogen in the horse. Arch. practice veterinarian 1923;50:22-37.
• Golub B, Falk G, Spink WW. Lung abscess due to Corynebacterium equi. Report of first human infection. Ann Intern Med. 1967;66(6):1174-7
• Nath SR, Mathew AP, Mohan A, Anila KR. Rhodococcus equi granulomatous mastitis in an immunocompetent patient. J Med Microbiol. 2013;62(8):1253-5.
• Goodfellow M, Alderson G. The actinomycete-genus Rhodococcus: a home for the “rhodochrous” complex. J Gen Microbiol. 1977;100(1):99-122.
• Verville TD, Huycke MM, Greenfield RA, Fine DP, Kuhls TL, Slater LN. Rhodococcus equi infections of humans. 12 cases and a review of the literature. Medicine (Baltimore). 1994;73(3):119-32.
• Arlotti M, Zoboli G, Moscatelli GL, et al. Rhodococcus equi infection in HIV-positive subjects: a retrospective analysis of 24 cases. Scand J Infect Dis. 1996;28(5):463-467.
• Vergidis P, Ariza-Heredia EJ, Nellore A, et al. Rhodococcus Infection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients1. Emerg Infect Dis. 2017;23(3):510-2.
• Weinstock DM, Brown AE. Rhodococcus equi: an emerging pathogen. Clin Infect Dis. 2002;34(10):1379-85.
• Barton MD, Hughes KL. Ecology of Rhodococcus equi. Vet Microbiol. 1984;9(1):65-76.
• Prescott JF. Rhodococcus equi: An animal and human pathogen. Clin Microbiol Rev 1991;4(1):20-34.
• Meijer WG, Prescott JF. Rhodococcus equi. Vet Res. 2004;35(4):383-96.
• Arya B, Hussian S, Hariharan S. Rhodococcus equi pneumonia in a renal transplant patient: a case report and review of literature. Clin Transplant. 2004;18(6):748-52.
• Rallis G, Dais P, Gkinis G, Mourouzis C, Papaioannou V, Mezitis M. Acute osteomyelitis of the mandible caused by Rhodococcus equi in an immunocompromised patient: a case report and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;114(4):e1-e5.
• Brown E, Hendler E. Rhodococcus peritonitis in a patient treated with peritoneal dialysis. Am J Kidney Dis. 1989;14(5):417-8.
• Tang S, Lo CY, Lo WK, Ho M, Cheng IK. Rhodococcus peritonitis in continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant. 1996;11(1):201-2.
• Nath SR, Mathew AP, Mohan A, Anila KR. Rhodococcus equi granulomatous mastitis in an immunocompetent patient. J Med Microbiol. 2013;62(8):1253-1255.
• Napoleão F, Damasco PV, Camello TC, et al. Pyogenic liver abscess due to Rhodococcus equi in an immunocompetent host. J Clin Microbiol. 2005;43(2):1002-4.
• Dalal P, Dalal T, Shah G. Hemodialysis catheter related Rhodococcus bacteremia in immunocompetent host. Saudi J Kidney Dis Transpl. 2011;22(4):761-3.
• Sandkovsky U, Sandkovsky G, Sordillo EM, Polsky B. Rhodococcus equi infection after reduction mammaplasty in an immunocompetent patient. Rev Inst Med Trop Sao Paulo. 2011;53(5):291-4.
• Scott MA, Graham BS, Verrall R, Dixon R, Schaffner W, Tham KT. Rhodococcus equi--an increasingly recognized opportunistic pathogen. Report of 12 cases and review of 65 cases in the literature. Am J Clin Pathol. 1995;103(5):649-55.
• Gundelly P, Suzuki Y, Ribes JA, Thornton A. Differences in Rhodococcus equi infections based on immune status and antibiotic susceptibility of clinical isolates in a case series of 12 patients and cases in the literature. Biomed Res Int. 2016;2016:2737295.
• Egawa T, Hara H, Kawase I, et al. Human pulmonary infection with Corynebacterium equi. Eur Respir J. 1990;3(2):240-2.
• Linares MJ, López-Encuentra A, Perea S. Chronic pneumonia caused by Rhodococcus equi in a patient without impaired immunity. Eur Respir J.1997;10(1):248-50.
• Harvey RL, Sunstrum JC. Rhodococcus equi infection in patients with and without human immunodeficiency virus infection. Rev Infect Dis. 1991;13(1):139-45.
• McNeil MM, Brown JM. Distribution and antimicrobial susceptibility of Rhodococcus equi from clinical specimens. Eur J Epidemiol. 1992;8(3):437-43.
• Yamshchikov AV, Schuetz A, Lyon GM. Rhodococcus equi infection. Lancet Infect Dis. 2010;10(5):350-9.
• Cisek AA, Rzewuska M, Witkowski L, Binek M. Antimicrobial resistance in Rhodococcus equi. Acta Biochim Pol. 2014;61(4):633-8.
• Kedlaya I, Ing MB, Wong SS. Rhodococcus equi infections in immunocompetent hosts: case report and review. Clin Infect Dis 2001;32(3):E39-46.
• Müller F, Schaal KP, von Graevenitz A, et al. Characterization of Rhodococcus equi-like bacterium isolated from a wound infection in a noncompromised host. J Clin Microbiol. 1988;26(4):618-20.
• Castor B, Ursing J, Aberg M, Pålsson N. Infected wounds and repeated septicemia in a case of factitious illness. Scand J Infect Dis. 1990;22(2):227-32.
• Bouchou K, Cathébras P, Dumollard JM, et al. Chronic osteitis due to Rhodococcus equi in an immunocompetent patient. Clin Infect Dis. 1995;20(3):718-20.
• Nasser AA, Bizri AR. Chronic scalp wound infection due to Rhodococcus equi in an immunocompetent patient. J Infect. 2001;42(1):67-8.
• García Morillo JS, Mellado P, Val Martín-Sanz M, Muniz Grijalvo O. Piomiositis primaria por Rhodococcus spp. en un paciente inmunocompetente. Med Clin (Barc). 2002;119:277-8.
• Sistla S, Karthikeyan S, Biswas R, Parija SC, Patro Dilip K. Acute osteomyelitis caused by Rhodococcus equi in an immunocompetent child. Indian J Pathol Microbiol. 2009;52:263-4.
• Devi P, Malhotra S, Chadha A. Bacteremia due to Rhodococcus equi in an immunocompetent infant. Indian J Med Microbiol. 2011 29(1),65–68.
• Sandkovsky U, Sandkovsky G, Sordillo EM, Polsky B. Rhodococcus equi infection after reduction mammaplasty in an immunocompetent patient. Rev Inst Med Trop Sao Paulo. 2011;53(5):291-4.
• Dias M, Bhat P, Chandrakar S, Pinto H. Rhodococcus equi: a pathogen in immunocompetent patients. J Family Med Prim Care. 2013;2(3):291-3.
• Nath SR., Mathew AP., Mohan A., Anila KR. Rhodococcus equi granulomatous mastitis in an immunocompetent patient. J Med Microbiol. 2013;62:1253–5.