Online publication April 10, 症例報告 Helicobacter cinaedi 1 要旨 : 60 1 CRP 17.5 CT 7.5 cm Helicobacter cinaedi Sulbactam/Ampicillin S/A 30 4 J Jpn
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1 Online publication April 10, 症例報告 Helicobacter cinaedi 1 要旨 : 60 1 CRP 17.5 CT 7.5 cm Helicobacter cinaedi Sulbactam/Ampicillin S/A 30 4 J Jpn Coll Angiol 2014; 54: Key words: mycotic aneurysm, Helicobacter cinaedi, bacteremia 序言 Helicobacter Helicobacter pylori H. pylori Helicobacter 2003 Helicobacter cinaedi H. cinaedi 1 H. cinaedi H. cinaedi 1 症例 60 9 ethionamide + PZA + LVFX doi: /jca CT SpO 2 97 room air 129/50mmHg 87/min 38.2 C 8,600/μl CRP 17.5 mg/dl Hgb 10.7 g/dl Plt /μl TP 6.1 g/dl Alb 3.2 g/dl Cr 7.26 mg/dl CT 8 CT retrospective 2.5 cm Fig. 1 CT 7.8 cm Fig. 2 3DCT Fig
2 52 Figure 1 Plain CT showed left deep femoral artery aneurysm at 8 month before surgery. Figure 2 Two-demensional CT angiogram showed the aneurysm with mural thrombus and a halo enhancement of aneurismal wall at the left deep femoral artery. Figure 4 Positive blood culture revealed a spiral, helical gram-negative rods (arrow) via the BACTEC FX system (Japan Becton Dickinson and Company). Figure 3 Three-dimensional CT angiogram showed a large saccular shaped aneurysm at the left proximal deep femoral artery. The maximum diameter of the aneurysm was 78 mm. back flow MRSA ml Empiric therapy Ceftazidime 1 g/ 5 2 BACTEC Fig C H. cinaedi H. cinaedi Imipenem-Cilastatin 500 mg/ 10 Sulbactam-Ampicillin 3 g/ 14 4 脈管学 Vol. 54
3 53 Figure 5 Postoperative plain CT 2 month later (A) and 4 month later (B). The aneurysm had diminished in size. A B CRP 0.9 mg/dl 30 Sulbactam-Ampicillin 1 CT 2 4 Fig. 5 CRP 1 考 Helicobacter cinaedi 1984 Fennell 2 homosexual cinaedi pylori AIDS 3 6 7, CT H. cinaedi vasa vasorum 9 9 H. cinaedi H. cinaedi 察 H. cinaedi Campylobacter H. cinaedi PCR 16SrRNA Campylobacter PCR in vitro
4 54 16 H. cinaedi 3 2 in-situ , 8 back flow H. cinaedi H. cinaedi H. pylori H. cinaedi 12 CT 8 結論 H. cinaedi 1 利益相反 文献 1 Murakami H, Goto M, Ono E, et al: Isolation of Helicobacter cinaedi from blood of an immunocompromised patient in Japan. J Infect Chemother 2003; 9: Fennell CL, Totten PA, Quinn TC, et al: Characterization of Campylobacter-like organisms isolated from homosexual men. J Infect Dis 1984; 149: Kiehlbauch JA, Tauxe RV, Baker CN, et al: Helicobacter cinaedi-associated bacteremia and cellulitis in immunocompromised patients. Ann Intern Med 1994; 121: Helicobacter cinaedi 2010; 51: H.cinaedi 2012; 53: Matsumoto T, Goto M, Murakami H, et al: Multicenter study to evaluate bloodstream infection by Helicobacter cinaedi in Japan. J Clin Microbiol 2007; 45: Helicobacter cinaedi ; 21: Helicobacter cinaedi ; 22: ja.ja.html 10 Kiehlbauch JA, Brenner DJ, Cameron DN, et al: Genotypic and phenotypic characterization of Helicobacter cinaedi and Helicobacter fennelliae strains isolated from humans and animals. J Clin Microbiol 1995; 33: Kitamura T, Kawamura Y, Ohkusu K, et al: Helicobacter cinaedi cellulitis and bacteremia in immunocompetent hosts after orthopedic surgery. J Clin Microbiol 2007; 45: Misawa N, Kawashima K, Kondo F, et al: Isolation and characterization of Campylobacter, Helicobacter, and Anaerobiospirillum strains from a puppy with bloody diarrhea. Vet Microbiol 2002; 87: Helicobacter cinaedi 2007; 81: Helicobacter 2008; 18: 脈管学 Vol. 54
5 55 15 Kuijper EJ, Stevens S, Imamura T, et al: Genotypic identification of erythromycin-resistant Campylobacter isolates as Helicobacter species and analysis of resistance mechanism. J Clin Microbiol 2003; 41: Weir S, Cuccherini B, Whitney AM, et al: Recurrent bacteremia caused by a Flexispira -like organism in a patient with X-linked (Bruton s) agammaglobulinemia. J Clin Microbiol 1999; 37: Matsunaga N, Ohkusu K, Nakamura I, et al: First report of Helicobacter cinaedi infective endocarditis (abstract). 20th European Congress of Clinical Microbiology and Infectious Diseases 2010; R2370: S709 A Case of Mycotic Deep Femoral Artery Aneurysm due to Helicobacter cinaedi Bacteremia Kiyoaki Niimi, Toshihiko Ichihara, and Michio Sasaki Department of Cardiovascular Surgery, Tosei Hospital, Aichi, Japan Key words: mycotic aneurysm, Helicobacter cinaedi, bacteremia A 60-year-old woman with end-stage renal disease on hemodialysis, peripheral artery disease, chronic rheumatoid arthritis, and multi-drug resistant tuberculosis had complained of fever, left inguinal swelling, and pain. The level of CRP was 17.5 mg/dl and computed tomography displayed a left deep femoral artery pseudoaneurysm. We performed an emergency resection of the aneurysm and debridement. On day 5, Helicobacter cinaedi (H. cinaedi) was detected by blood culture. Imipenem-cilastatin was administered for 10 days and the antibiotic was switched to sulbactam-ampicillin for 1 month. There has been no recurrence for a period of 4 months. H. cinaedi could be a source of mycotic aneurysm in immunocompromised patients. (J Jpn Coll Angiol 2014; 54: 51 55) Online publication April 10, 2014
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