증식편에서 16S rRNA 직접 염기서열분석으로 진단한 Haemophilus parainfluenzae 심내막염
Haemophilus parainfluenzae Infective Endocarditis Diagnosed by Direct 16S rRNA Sequencing of Vegetation
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참고문헌
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초록
HACEK 군은 전체 심내막염 중 3-6%를 차지하며, 배양 음성 심내막염의 주요 원인이다. 혈액배양이 지연된 H. parainfluenzae 심내막염에서 증식편을 직접 염기서열 분석방법으로 진단한 증례를 보고한다. 건강했던 26세 남자가 2011년 3월 27일 간헐적 고열을 주소로 응급실에 내원하여 cefpodoxime을 5일간 처방받았다. 응급실과 입원 후 병실에서 각각 6쌍과 11쌍의 혈액배양 검사를 실시하였고 혈액은 BACTEC Plus Aerobic/F (Becton-Dickinson,USA)와 Lytic Anaerobic/F Plus (BD, USA)에 세트로 접종하였다. 심초음파 검사에서 승모판 후방에 큰 증식물이 관찰되어 심내막염으로 진단되었다. 입원 11일째 증식물 제거술 및 승모판 성형술을 시행한 후 증식편을 thioglycolate 액체배지, 혈액한천배지, 브루셀라 혈액한천배지, MacConkey 배지에 7일간 배양하였으나 균은자라지 않았다. 증식편에서 16S rRNA를 직접 염기서열 분석검사하여 H. parainfluenzae를 동정하였다. 입원 9일째 시행한 5쌍의 배양 중 2쌍의 호기성병에서 혈액 배양 10일, 14일 만에 균이 배양되었다. VITEK NHI card (bioMerieux, France)를 이용하여 H. parainfluenzae로동정하였다. 감염성 심내막염, 특히 배양 음성 심내막염 환자에서 증식편을 직접 염기서열 분석하여 원인균을 동정하는 것은 매우 유용한 진단법이 될 것이다.
Abstract
The HACEK group of microorganisms is responsible for approximately 3-6% of endocarditis cases and is a major cause of culture-negative endocarditis. Here, we report a case of Haemophilus parainfluenzae infective endocarditis that was diagnosed by direct PCR sequencing of 16S rRNA from resected vegetation. A healthy 26-yr-old man was admitted to the emergency room (ER) on March 27, 2011 because of intermittent high fever. The patient was prescribed cefpodoxime for 5 days at the ER. Six and 11 sets of blood cultures were performed at the ER and in a general ward, respectively, using BACTEC Plus Aerobic/F (Becton-Dickinson, USA) and Lytic Anaerobic/F Plus (BD) together. Echocardiography revealed a large vegetation at the posterior mitral valve leaflet. After performing mitral valvoplasty on hospital day (HD) 11, the vegetation tissue was cultured in thioglycolate broth, blood agar, Brucella agar, and MacConkey agar for 7 days, but no organism was grown. Direct PCR sequencing of 16S rRNA of the tissue revealed the presence of H. parainfluenzae. In the 17 sets of blood cultures, bacterial growth was detected in only 2 aerobic bottles of 5 sets taken at HD 9 after 10-day and 14-day incubation. The organism was identified as H. parainfluenzae by using the VITEK NHI card (bioMerieux, France). Direct PCR sequencing of vegetation could be useful in diagnosing bacterial pathogens in infective endocarditis patients, especially in culture-negative cases.
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