중심정맥관 관련 Tsukamurella pulmonis 균혈증 1예
A Case of Catheter-Related Bacteremia of Tsukamurella pulmonis
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Tsukamurella pulmonis는 호기성 actinomycetes에 속한 다. 저자들은 T. pulmonis 균혈증 1예를 경험하여 보고하고자 한다. 급성림프성 백혈병인 39세 남자가 입원 9일째 골수 이식 을 받았다. 7일째 고열이 발생하여 vancomycin을 추가한 후 열 이 해소되었으나 vancomycin, meropenem, amphotericin B 치료를 계속하였는데도 16일째 고열이 재발하여 19일째 Hickman 카테터(HC)를 제거하였다. 7, 16, 19일째 각각 HC를 통해 채혈한 혈액 한 쌍과 말초 혈관의 혈액 두 쌍 등 3쌍씩 혈액배양 을 실시하였고, 제거했던 HC의 말단부도 배양하였다. HC로 채 취한 혈액배양의 모든 호기성 병과 말초혈관에서 얻은 혈액 한 병, HC 말단부 배양에서 길고, 가는 반듯한 그람양성 막대균이 분리되었고, 변법 Kinyoun 염색에 양성이었다. 배양 3일째에 작고 비용혈성의 회색의 거친 집락이 자랐고, 배양을 연장하면 집락이 크고 납작해졌다. 균은 catalase, urease 양성이었으며 triple sugar iron 한천배지에서 알칼리 사면/알칼리 고층반응 을 보이고, hypoxanthine을 분해하였다. 1,296 bp의 16S rRNA 염기서열 분석결과 T. pulmonis DSM 44142T과 100% 일치하 였다. 본 증례는 T. pulmonis에 의한 국내 첫 균혈증 보고이다.
Abstract
Tsukamurella pulmonis is an aerobic actinomycete. We report a catheter-related bacteremia of T. pulmonis. A 39 yr-old male with ALL was hospitalized to receive bone marrow transplantation (BMT). Although the patient developed a high fever at the 7th hospital day (HD), it subsided with vancomycin treatment, and he received BMT at 9th HD. Fever resurged at 16th HD despite sustained treatment with vancomycin, meropenem, and amphotericin B, but subsided with removal of Hickman catheter (HC) at 19th HD. Three sets of blood cultures comprising one from the HC and two from venipunctures were taken at 7th, 16th, and 19th HD, and the distal tip of the HC was also cultured. The aerobic vials of all 3 HC-withdrawn blood cultures and one peripheral blood culture taken at 19HD and the HC tip culture grew long, straight, thin gram-positive rods that were positive on modified Kinyoun stain. This organism showed tiny, rough, grey colonies after 3-day incubation and grew to large flat colonies when incubation was extended. It was catalase-positive, ureasepositive, and alkaline-slant/alkaline-deep on triple sugar iron agar, and hydrolyzed hypoxanthine. The sequence of 1,296 base pairs of 16S rRNA of this organism showed a 100.0% homology with the published sequence of T. pulmonis DSM 44142T. To our knowledge, this is the first report of T. pulmonis bacteremia in Korea.
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