Arcanobacterium haemolyticum 패혈증 1예 = A Case of Arcanobacterium haemolyticum Sepsis

다국어 초록 (Multilingual Abstract)

Arcanobacterium haemolyticum is a beta-hemolytic coryneform bacillus. It has been implicated as an etiologic agent of non-streptococcal pharyngitis and less frequently a cause of skin and wound infections, osteomyelitis, pneumonia, endocarditis, sepsis, and central nervous system infections. We describe a case of A. hemolyticum sepsis reported for the first time in Korea. A 61- year-old man with a diabetic foot was admitted due to a high fever. Three sets of blood cultures taken at the emergency room yielded coryneform bacilli. The organism was beta-hemolytic on blood agar plate, catalase-negative, and non-motile. It was identified as A. haemolyticum by Rapid CB Plus (Remel, Kansas, USA) and API Coryne (BioMerieux SA, Marcy l’Etoile, France) and confirmed by CAMP inhibition reaction. It was susceptible to penicillin, ceftriaxone, erythromycin, ciprofloxacin, and vancomycin by the disk diffusion method using the breakpoint criteria of National Committee for Clinical Laboratory Standards for streptococci other than Streptococcus pneumoniae. The patient was improved with partial amputation of the right big toe and antimicrobial therapy with ampicillin/sulbactam. If Arcanobacterium is isolated from normally sterile sites or culture specimens properly collected from infected tissues, it should be identified to the species level. Commercial biochemical test kits specialized in corynebacteria and CAMP test are useful for species identification of A. haemolyticum

국문 초록 (Abstract)

Arcanobacterium haemolyticum 은 베타용혈성 coryneform 간균으로 비연쇄상구균성 인후염의 원인균으로 생각되며, 드물게 피부와 창상감염, 척수골수염, 폐렴, 심내막염, 패혈증, 중추신경계감염 등을 일으킨다. 그러나 국내에는A. haemolyticum에 대 한감염보고가 없다. 저자 등은 고열을 주소로 내원한 61세 남자환자의 혈액에서A. haemolyticum을 분리하였기에 보고하는 바이다.이 증례는 국내문헌상 첫 A. haemolyticum 패혈증으로 사료된다. 환자는 당뇨성 족부병변을 가진 61세 환자로 고열을 주소로내원하였다. 응급실에서 시행한 3쌍의 혈액배양에서 coryneform간균이 배양되었다. 이 균은 혈액한천배지에서 베타용혈성을 나타내었고, catalase 음성, 비운동성이었다. Rapid CB plus (Remel,Kansas, USA) 킷트와 API Coryne (BioMerieux SA, Marcyl'Etoile, France) 킷트를 사용한검사에서A. haemolyticum이 동정되었으며, CAMP 검사에 억제반응을 보여 A. haemolyticum임을 확인하였다. Streptococcus pneumoniae외의 streptococci에대한 National Committee for Clinical Laboratory Standards의디스크 확산법과 breakpoint 기준으로 항균제 감수성 검사를 시행한 결과 이 균은 penicillin, ceftriaxone, erythromycin, ciprofloxa-cin, vancomycin에 감수성이었다. 환자는 왼쪽 엄지발가락의 부분적 절단술과 ampicillin/sulbactam의 항균제 치료로 호전되었다. A. haemolyticum이 정상적으로 무균상태인 검체에서 분리되었거나 감염조직에서 적절한 방법으로 채취하여 배양한 검체에서 분리되었을 경우에는 종수준의 동정을 해주는 것이 필요하다.A. haemolyticum의 동정에는 상품화된 corynebacteria용 생화학적 동정키트와 CAMP 검사가 유용하다.

참고문헌 (Reference)

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