급성 충수염 환자의 혈액배양에서 동시에 분리된 Catabacter hongkongensis와 Alistipes indistinctus 1예
A Case of Catabacter hongkongensis and Alistipes indistinctus Isolated from Blood Cultures of a Patient with Acute Appendicitis
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Catabacter hongkongensis는 혐기성 그람 양성 구간균으로 홍콩에서 처음 동정되었다. 드물지만 기저질환이 있는 환자들에게서 감염되어 높은 사망을 일으키는 병원균이다. Alistipes indistinctus는 혐기성 그람 음성 구간균이다. 이 균은 장내 정상 세균총으로 알려져 있다. 본 증례에서는 급성 충수염 환자의 혈액 배양 검사에서 C. hongkongensis와 A. indistinctus가 동시에 동정된 1예를 보고하고자 한다. 특이 병력 없는 35세 여자 환자로 내원 전일 발생한 복통과 구토, 구역감, 설사증상으로 병원에 입원하였다. 입원하여 시행한 혈액 검사상 백혈구 수 상승, 호중구증가증, C-반응 단백 상승 그리고 프로칼시토닌 상승 소견 보였다. 복부 CT상 천공이 의심되는 급성충수염으로 응급 수술하였다. 이때 시행한 혈액배양에서 4일만에 두 개의 혐기성 배양병에서 양성 신호를 보였다. 브루셀라 배지에 계대배양하였고 그람 양성과 그람 음성 구간균이 분리되었다. MALDI-TOF MS로 동정이 되지 않아 16S rRNA gene 염기서열 분석을 시행하였고, 각각 C. hongkongensis와 A. indistinctus임을 확인하였다. 환자는 수술과 경험적 항생제 투여 후 증상 호전되어 2일 후 퇴원하였다. MALDI-TOF MS는 보다 빠르고 정확한 세균 동정이 가능하지만 C. hongkongensis와 A. indistinctus처럼 스펙트럼 라이브러리에 없는 상기 두 균의 동정에는 16S rRNA gene 염기서열 분석이 유용하였다.
Abstract
Catabacter hongkongensis is an anaerobic gram-positive coccobacillus that was first isolated in Hong Kong. It is infectious and causes high mortality in patients with rare but underlying diseases. Alistipes indistinctus is an anaerobic gram-negative coccobacillus. This bacterium is a common member of the human intestinal microbiota. We report a case of C. hongkongensis and A. indistinctus isolated from blood cultures of a patient with acute appendicitis. A 35-year-old female patient with no specific medical history was admitted to the hospital due to abdominal pain, vomiting, nausea, and diarrhea experienced on the day before admission. On admission, laboratory tests revealed leukocytosis, neutropenia, and elevated C–reactive protein and procalcitonin levels. Following an abdominal computed tomography showing acute appendicitis with suspected perforation, emergency surgery was performed. Growth was observed in two anaerobic blood culture bottles after four days. After further culturing of the bacteria on Brucella Blood Agar, two types of bacteria were obtained. The two bacterial isolates, one gram-positive and one gram-negative, were unable to be identified using matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS). Thus, 16S rRNA gene sequence analysis was performed, resulting in identification of the bacteria as C. hongkongensis and A. indistinctus. The patient was administered antibiotics and discharged two days after surgery. Although MALDI-TOF MS enables fast and accurate identification of bacteria, C. hongkongensis and A. indistinctus were not listed in the spectral library, and 16S rRNA gene sequence analysis was useful for identifying the two bacteria.
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