RESUMO
We report a case of rat bite fever, diagnosed based on positive cultures of Streptobacillus moniliformis from blood and synovial fluid. The patient was a 45-year-old man who presented with history of a rat bite and alcoholic liver cirrhosis. He had been bitten on his third finger by a rat, which was caught in a mousetrap installed in his house. Over the course of approximately 2 weeks after the bite, the patient developed fever, rash, and arthralgia. The patient was admitted to our hospital and treated with a combination of ampicillin-sulbactam, vancomycin (VAN), and minocycline (MIN) antibiotics. Initial culture findings from the Anaerobic/F resin blood culture were positive for gram-negative bacillus after overnight incubation. Thus, S. moniliformis infection was suspected, and administration of VAN and MIN was ceased. On hospital day 8, the treatment was switched to oral amoxicillin-clavulanic acid, and the patient was discharged from the hospital. Subsequently, the pathogen was also detected in synovial fluid and identified as S. moniliformis using 16S rRNA sequencing analysis.
Assuntos
Febre por Mordedura de Rato/diagnóstico , Febre por Mordedura de Rato/patologia , Streptobacillus/isolamento & purificação , Antibacterianos/uso terapêutico , Técnicas Bacteriológicas , Sangue/microbiologia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Humanos , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Febre por Mordedura de Rato/tratamento farmacológico , Febre por Mordedura de Rato/microbiologia , Análise de Sequência de DNA , Streptobacillus/classificação , Streptobacillus/genética , Líquido Sinovial/microbiologia , Resultado do TratamentoRESUMO
We bacteriologically and genetically analysed 30 cephalosporin-resistant Escherichia coli strains isolated from specimens from 19 neurology-ward inpatients at our hospital over the 3 years from April 2006 to March 2009, surveying and comparing subjects' backgrounds. Of the 30, 19 (63%) were urine, 6 (20%) sputum, and 3 (10%) blood. We tested extended-spectrum beta-lactamase (ESBLs) production, found in all samples. PCR and gene sequencing showed that 25 strains (83%) were CTX-M-14 and 5 (17%) CTX-M-2. Among CTX-M-14 strains, two cluster groups I and II, were obtained using pulsed-field gel electrophoresis (PFGE). Cluster group I in particular, continued to be detected for 18 months in the same hospital room. The detection rate was high at 13 (68%) in subjects with urinary catheters and morbidity was high in those with a history of cerebrovascular disease, diabetes, and hypertension. Our findings suggest that genetically identical strains may become established and spread in hospitals possibly due to inadequate contact prevention, subjects' immune status, and risk factor existence.