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RISS 인기검색어
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- 저자 : ( Pilar Madelyn P. Rozul ) (검색결과 2 건)
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( Martin Kristoffer E. Ogbac ),( Pilar Madelyn P. Rozul ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
from a lung pathology. Tuberculosis is a common cause of SSP specially in endemic areas such as the Philippines. Organisms that causes pneumonia can also cause SSP. Among these, the most common are Staphylococcus, Klebsiella, Pseudomonas, and Pneumocystis. In patients with cystic fibrosis, the risk of SSP increases with Burkholderiacepaciaor Pseudomonas infection. We report a 37-year-old Filipino female, who had fever, cough, and lower back pain. Chest radiograph revealed left pneumothorax. Chest tube thoracostomy (CTT) was performed Antibiotics were started. Computed tomography revealed massive left pneumothorax and left lung relaxation atelectasis. Bronchoscopy reported moderate mucus. Bronchial aspirate revealed Klebsiella pneumoniae. Video-assisted thoracoscopic surgery (VATS) noted 300cc pleural fluid with septations and loculations; trapped left lower lobe by thick fibrin; 0.5 x 0.5cm pleural nodule; 4 x 2cm diaphragmatic mass. Pleural fluid revealed acid fast bacilli (AFB) and Pseudomonas aeruginosa. Diaphragmatic and pleural nodule histopathology reported chronic granulomatous inflammation with Langhan’s type giant cells consistent with tuberculosis. Anti-tuberculosis medications were started. CTT was subsequently removed. SSP due to tuberculosis results from diaphragmatic rupture due to pleural invasion by the organism with subsequent liquefactive necrosis. The same happens for pneumothorax due to other respiratory infections. Tuberculosis is diagnosed by identification of AFB in the sputum or pleural fluid. In endemic areas with inaccessible laboratory, diagnosis is made by high suspicion. There are limited cases of SSP secondary to tuberculosis with concomitant respiratory bacterial infection because pleural studies and bronchoscopy are not routinely done. Treatment consists of CTT and administration of both anti-tuberculosis and antibiotic medications. This case report of SSP secondary to tuberculosis with simultaneous respiratory bacterial infection of Pseudomonasand Klebsiellarecommends the inclusion of pleural fluid culture and AFB in the routine work-up of SSP. VATS and bronchoscopy are recommended to rule out other possible etiology.
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( Martin Kristoffer E. Ogbac ),( Pilar Madelyn P. Rozul ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: Sphingomonas paucimobilisis an aerobic, nonspore-forming, nonfermentative gram-negative bacillus and was known as Pseudomonaspaucimobilis. It is distributed in the natural environment and forms biofilm in water systems in hospitals and devices like nebulizers and ventilators. It is not a major pathogen with a low virulence, but several cases of severe infection have been reported with the organism being obtained from blood, sputum, urine, peritoneal fluid, and catheters. Case Summary: We report a 73-year-old Filipino male, who presented with difficulty of breathing. He was hypertensive, diabetic, and had chronic kidney disease (CKD) undergoing regular hemodialysis. He received treatment for pulmonary tuberculosis and underwent repeated thoracentesis for recurrent pleural effusions secondary to CKD. He was intubated for persistent dyspnea and was admitted at the intensive care unit. He was managed as severe sepsis secondary to pneumonia and was started on Piperacillin + Tazobactam and Azithromycin. Blood culture was negative for any bacteria. Tracheal aspirate culture revealed Enterobacter cloacae, which was sensitive to Piperacillin + Tazobactam. On the 13thhospital day, he developed persistent hypotension and desaturation. Noradrenaline drip was started and he was managed as septic shock secondary to ventilator-associated pneumonia. Antibiotics were shifted to Meropenem. Blood culture was negative. Tracheal aspirate revealed Extended Spectrum Beta-Lactamase positive Sphingomonas paucimobilis that was resistant to Meropenem. Antibiotics were changed to Ciprofloxacin however, persistent hypotension and desaturation recurred and despite additional inotropes, patient expired. Conclusion: The existence of Sphingomonas paaucimobilisin the natural environment does not pose any threat although recent literature shows that it can cause severe infection and shock among immunocompromised and critically-ill patients. In the Philippines, no published report has been made on its incidence. With the increasing episodes of antibiotic resistance and incidence of previous non-pathologic bacteria now causing severe infection, it is important that this organism be carefully studied and documented.
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