BORDETELLA TREMATUM’UN ETKEN OLDUĞU BİR KRONİK ORTA KULAK İNFEKSİYONU OLGUSU
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Tarih
2015
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bordetella trematum, kapsüllü, spor oluşturmayan, glikozu fermente etmeyen, katalaz pozitif, hareketli ve aerobik koşullarda 25-42C'de üreyen Gram negatif bir bakteridir. Optimal üreme sıcaklığı 35-37C olup, bu sıcaklıkta mikroaerofil olarak da üreyebilir. B.trematum'un insanlarda kulak, yara, diyabetik ülser ve kan akımı infeksiyonu etkeni olduğu gösterilmiştir. İlk izole edildiği 1996 yılından bugüne kadar 15 B.trematum infeksiyonu rapor edilmiştir. Bildiğimiz kadarıyla ülkemizde bildirilmiş B.trematum infeksiyonu olgusu bulunmamaktadır. Bu çalışmada B.trematum'un etken olduğu bir kronik orta kulak infeksiyonu olgusu sunulmuştur.Yirmibeş-otuz yıldır kulak akıntısı şikayeti olan 40 yaşındaki erkek hasta kulak burun boğaz (KBB) polikliniğine başvurmuştur. Fiziki muayenesinde sol kulaktan sarı renkli ve kötü kokulu akıntısı mevcut olan hastanın diğer sistem muayeneleri normal olarak değerlendirilmiştir. Hasta kronik otitis media tanısı ile yatırılıp alınan sol kulak akıntı örneği Tıbbi Mikrobiyoloji Laboratuvarı'na gönderilmiştir. Hastaya ampirik tedavi olarak piperasilin-tazobaktam (3x4.5 g) başlanmıştır. Örnekten hazırlanan yaymanın Gram boyamasında her alanda birkaç lökosit ve Gram negatif çomaklar görülmüştür. Akıntı örneği % 5 koyun kanlı agar ve Eosin Methylene Blue agar (EMB) besiyerlerine ekilmiştir. Kırksekiz saat inkübasyondan sonra kanlı agarda parlak, grimsi S koloniler; EMB besiyerinde ise laktoz negatif koloniler üremiştir. Koloniden yapılan Gram boyamada Gram negatif çomaklar görülmüştür. Bakteri VITEK 2 (bioMérieux, Fransa) ve Matriks Yardımlı Lazer İyonizasyon Kütle Spektrometresi (MALDI-TOF MS) (Bruker Daltonik GmbH, Almanya) otomatize sistemlerinde B.trematum olarak tanımlanmıştır. Antibiyotik duyarlılık testi E-test yöntemi ile yapılmıştır. Antibiyotik duyarlılık testi sonucuna göre piperasilin-tazobaktam, seftazidim, meropenem, kolistin ve amikasine duyarlı, sefepim ve sefotaksim orta duyarlı, siprofloksasine dirençli bulunmuştur. Antibiyotik duyarlılık testi sonucuna göre piperasilin-tazobaktam tedavisine devam edilmiştir. Akıntısı azalan hasta tedavisi 14 güne tamamlanıp şifa ile taburcu edilmiştir. Sonuç olarak, özellikle diyabetik hastalarda derin yumuşak doku infeksiyonlarında ve kronik orta kulak iltihabı olgularında B.trematum akla gelmelidir. B.trematum prevalansını, antibiyotik direnç oranlarını ve özellikle patojenitesini anlayabilmek için daha çok çalışmaya ihtiyaç vardır
Bordetella trematum is a capsulated, non-sporulating, glucose-non-fermenting, catalase positive, motile Gram negative rod that grows aerobically at 25-42C. Optimal growth temperature is 35-37C, and can grow under microaerophilic conditions at this temperature. B.trematum has been shown as a causative agent in wound, otitis media, diabetic ulcer, and bloodstream infections in humans. Fifteen strains of B.trematum have been isolated from human clinical material since its first description in 1996. To our knowledge, no case has been reported from our country. In this study, we report a case of chronic otitis media infection caused by B.trematum.A 40-year-old man, who has been complaining of ear discharge for 25-30 years, admitted to the Department of Otorhinolaryngology in our hospital. Physical examination of patient revealed smelly yellow ear discharge from the left ear. The examinations of other systems were normal. Patient was hospitalized with a diagnosis of chronic otitis media and a sample obtained from the left ear was sent to the Medical Microbiology Laboratory. Patient was emprically treated with piperacillin-tazobactam (3x4.5 g). A few leukocytes and Gram negative bacilli were seen in each area on Gram stain of the sample. The sample was inoculated to 5 % sheep blood and Eosin Methylene Blue (EMB) agar plates. After 48 hours of incubation, shiny, grayish S colonies in 5 % sheep blood agar and lactose negative colonies in EMB agar were observed. Gram negative bacilli were seen in the Gram stain of the colonies. The isolate was identified as B.trematum using VITEK 2 automated system (bioMérieux, France) and Matrix Assisted Laser Ionization Mass Spectrometer (Bruker Daltonik GmbH, Germany). E-test method was used for antibiotic susceptibility testing. B. trematum was susceptible to piperacillin-tazobactam, ceftazidime, meropenem, colistin and amikacin. The isolate was intermediate for cefepime, cefotaxime and resistant to ciprofloxacin. Piperacillin-tazobactam therapy was continued according to the antibiotic suscebtibility test results. Ear discharge decreased, and the patient was discharged with healing after 14 days of treatment.B.trematum might be the cause of soft tissue infections in patients with diabetes mellitus and in cases of chronic otitis media. Further studies are needed to improve knowledge about the prevalence, antibiotic resistance rates, particularly pathogenicity of the bacterium
Bordetella trematum is a capsulated, non-sporulating, glucose-non-fermenting, catalase positive, motile Gram negative rod that grows aerobically at 25-42C. Optimal growth temperature is 35-37C, and can grow under microaerophilic conditions at this temperature. B.trematum has been shown as a causative agent in wound, otitis media, diabetic ulcer, and bloodstream infections in humans. Fifteen strains of B.trematum have been isolated from human clinical material since its first description in 1996. To our knowledge, no case has been reported from our country. In this study, we report a case of chronic otitis media infection caused by B.trematum.A 40-year-old man, who has been complaining of ear discharge for 25-30 years, admitted to the Department of Otorhinolaryngology in our hospital. Physical examination of patient revealed smelly yellow ear discharge from the left ear. The examinations of other systems were normal. Patient was hospitalized with a diagnosis of chronic otitis media and a sample obtained from the left ear was sent to the Medical Microbiology Laboratory. Patient was emprically treated with piperacillin-tazobactam (3x4.5 g). A few leukocytes and Gram negative bacilli were seen in each area on Gram stain of the sample. The sample was inoculated to 5 % sheep blood and Eosin Methylene Blue (EMB) agar plates. After 48 hours of incubation, shiny, grayish S colonies in 5 % sheep blood agar and lactose negative colonies in EMB agar were observed. Gram negative bacilli were seen in the Gram stain of the colonies. The isolate was identified as B.trematum using VITEK 2 automated system (bioMérieux, France) and Matrix Assisted Laser Ionization Mass Spectrometer (Bruker Daltonik GmbH, Germany). E-test method was used for antibiotic susceptibility testing. B. trematum was susceptible to piperacillin-tazobactam, ceftazidime, meropenem, colistin and amikacin. The isolate was intermediate for cefepime, cefotaxime and resistant to ciprofloxacin. Piperacillin-tazobactam therapy was continued according to the antibiotic suscebtibility test results. Ear discharge decreased, and the patient was discharged with healing after 14 days of treatment.B.trematum might be the cause of soft tissue infections in patients with diabetes mellitus and in cases of chronic otitis media. Further studies are needed to improve knowledge about the prevalence, antibiotic resistance rates, particularly pathogenicity of the bacterium
Açıklama
Anahtar Kelimeler
Farmakoloji ve Eczacılık
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ANKEM Dergisi
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Cilt
29
Sayı
3
