Publish Time: 2023-08-09 Origin: Site
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In July 2023, the team of Professor Han Wei from Qingdao Hospital of Rehabilitation University (Qingdao Municipal Hospital)International Journal of Infectious Diseases（IF=8.4）magazine publishedA case report of Copperophilus Girardi infection in convalescent patients with COVID-19, to explore the clinical value of mNGS technology in the rapid diagnosis of rare pathogen infection.
/ Research Background /
Copperophilus giraldi (Cupriavidus gilardii）It is an aerobic Gram-negative bacillus, first named after the famous American microbiologist GL Gilardii.It is characterized by perinatal flagella and cannot ferment glucose. It is a widely distributed environmental organism.It has been isolated sporadically from blood, throat, stool and abscess specimens.Previous reports wouldC. gilardii It is described as a low pathogenic microorganism, which can mainly cause opportunistic infections, and shows sensitivity to various antibacterial drugs such as cefepime and levofloxacin.
To date, only 5 cases have beenC. gilardii Cases of clinical infection have been reported.Among them, 3 patients had underlying immunosuppression (acute lymphoblastic leukemia, aplastic anemia, and kidney transplant recipients), and 4 patients underwent invasive procedures.However, the clinical significance of Copperophilus giraldi remains unclear.
/ Case introduction /
A 78-year-old man was hospitalized with dyspnea and limb edema.
The patient had a history of hypertension and coronary heart disease for many years; he underwent heart bypass surgery 13 years ago; he underwent radical prostatectomy 4 years ago and did not receive any postoperative radiotherapy or chemotherapy.
The patient was hospitalized for COVID-19 pneumonia one month ago, and after treatment with corticosteroids, non-invasive ventilator-assisted ventilation, and antibiotic therapy, he was discharged after CT re-examination showed that the infection had subsided.However, 3 days after discharge, the patient developed progressive dyspnea and limb edema, and was re-admitted 3 days later.
Admission diagnosis and treatment
Laboratory examination when the patient was admitted: the total number of white blood cells was 7.72*109/L, of which lymphocytes (T cell lymphoma 53.88%, differentiation cluster [CD4+] 47.03%, [CD8+] 11.95%) 2.8%, monocytes 1.2%, neutrophils 96%, hemoglobin 171g/l, platelets 77×109/l, C-reactive protein 154 mg/l.Arterial partial pressure of oxygen was 80.8 mm Hg.(1,3)-β-glucan content was 242.21pg/ml.Other laboratory indicators were within the normal range.However, CT showed double lung infection and enlarged lesions.
HD1(1st day of admission) According to the results of blood routine and CT examination, piperacillin-tazobactam (4.5g/8h) and voriconazole (0.2g/2h) were administered intravenously.
further examination and treatment
HD4 The patient underwent bronchoscopy and alveolar lavage, and two samples of alveolar lavage fluid and peripheral blood were sent for mNGS detection at the same time.
HD6 The results of mNGS reported that both samples were detectedC. gilardii and Aspergillus fumigatus, of whichC. gilardii The number of sequences is 251485 and 175, and the coverages are 85.42% and 0.30% respectively (Figure 1).Since there is currently noC. gilardii Guidelines for the treatment of infections, seeC. gilardii After relevant cases of infection were reported, piperacillin-tazobactam was discontinued, and intravenous imipenem/cilastatin (0.5g/6h) and micafungin (0.1g/1d) were used for antibacterial treatment , Oral trimethoprim-sulfamethoxazole (0.24g~1.2g/8 h).
Figure 1 BALF and peripheral blood samplesC. gilardiioverlay
HD7 The culture results of alveolar lavage fluid in the hospital were positive for Copperphyll sp. and Aspergillus fumigatus, and the blood culture results were negative.
HD8 The patient's oxygen saturation further deteriorated, and endotracheal intubation and mechanical ventilation were performed.Blood routine showed: white blood cells 7.95×109/l (4.8% lymphocytes, 1.4% monocytes and 93.7% neutrophils), CRP 290.5 mg/l, PCT 16.62ng/ml, suggesting that the patient may have serious infection.
HD10 Follow-up X-rays showed aggravated pulmonary inflammation.
Outcome and Prognosis
HD12 The patient's condition continued to deteriorate, and he died of multiple organ failure caused by severe pneumonia and sepsis.
Summarize
1. Copperophilus Girardi is an aerobic Gram-negative bacillus that rarely causes infection and can opportunistically infect immunocompromised patients. Its clinical significance still needs to be further explored.
2. This study is the first to report a case of lung infection and severe sepsis caused by Copperophilus giraldi following COVID-19 and corticosteroid use, and to isolate the pathogen from alveolar lavage fluid for the first time.However, the effectiveness of the selected antibiotic regimen could not be assessed due to the severe infection and poor prognosis of the patient.
3. mNGS can perform rapid and comprehensive pathogen screening, help the diagnosis of rare bacterial infections, and provide clinical experience for their treatment.
references:
Fang X, Lu K, Sun S, Zhang H, Yu X, Han W. Infection caused by Cupriavidus gilardii in a convalescent COVID-19 patient [published online ahead of print, 2023 Jul 20]. Int J Infect Dis. 2023;134 :287-289. doi:10.1016/j.ijid.2023.07.015
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