Volume 20, Number 11—November 2014
Letter
Helicobacter cinaedi Infection of Abdominal Aortic Aneurysm, Japan
Table
Clinical characteristics of 3 patients with Helicobacter cinaedi–infected abdominal aortic aneurysms and molecular characteristics of isolates, Japan *
Characteristic | Case-patient 1 | Case-patient 2 | Case-patient 3 |
---|---|---|---|
Age, y/sex | 64/M | 59/M | 62/M |
Underlying diseases | Hypertension, hyperlipidemia | None | History of myocardial infarction |
Risk factors for infection | None | None | None |
Clinical signs and symptoms before surgery |
Fever, back pain |
Fever, abdominal pain |
Low back pain |
CT results | |||
Site of aneurysm | Infrarenal abdominal, bilateral common iliac, internal iliac, L femoral, aortic arch† | Infrarenal abdominal, bilateral common iliac | Infrarenal abdominal |
Inflammatory findings around
aneurysms |
+ |
+ |
+ |
Maximum leukocyte count/μL)/C-reactive protein, mg/dL before operation | 10,600/25.3 | 9,100/6.05 | 7,050/ 5.29 |
Surgical management |
In situ grafting |
In situ grafting |
In situ grafting |
Microbiological diagnosis | |||
Blood culture | – | – | – |
Tissue culture | – | – | +‡ |
rRNA gene sequence similarity, %§ | |||
16S | 99.8 | 99.6 | 99.6 |
23S | 99.8 | 99.8 | 99.8 |
Amplification of gyrB specific to H. cinaedi | + | + | + |
Aneurysms in which H. cinaedi
was identified |
Infrarenal abdominal, L common iliac, R internal iliac, L femoral |
Infrarenal abdominal |
Infrarenal abdominal |
MLST | ST15 (CC7) | ST10 (CC9) | ST10 (CC9) |
Mutation of 23S rRNA gene and amino acid substitutions in GyrA |
2018 A→G and T84I D88G |
2018 A→G and T84I |
2018 A→G and T84I |
Antimicrobial therapy dosage and duration | |||
Before admission | Ceftriaxone, 2 g/d, and levofloxacin, 500 mg/d, for 2 d | Piperacillin/tazobactam, 4.5 g/d for 12 d; faropenem sodium hydrate, 600 mg/d for 10 d | Oral antimicrobial agent, 4 d |
After admission | Doripenem, 1.5 g/d for 22 d, and vancomycin, 3.0 g/d, for 14 d | Piperacillin/tazobactam, 4.5 g/d for 28 d | Doripenem, 1.5 g/d for 28 d |
After identification of pathogen | Sulbactam/ampicillin, 3.0 g/d, and minocycline, 100 mg/d for 25 d | Continuation of piperacillin/tazobactam | Continuation of doripenem |
At discharge |
Oral amoxicillin, 1,500 mg/d, and minocycline, 200 mg/d, until follow-up visit |
Oral amoxicillin, 1,500 mg/d, and minocycline, 200 mg/d, until follow-up visit |
Oral amoxicillin, 1,500 mg/d, and minocycline, 200 mg/d, until follow-up visit |
Postoperative complications | None | None | None |
Outcome | Survived | Survived | Survived |
*CT, computed tomography; +, positive; –, negative; L, left; R, right; MLST, multilocus sequence typing; ST, sequence type; CC, clonal complex; A, adenine; G, guanine; T, threonine; I, isoleucine; D, aspartic acid; G, glycine.
†Aortic arch was replaced 5 weeks after the abdominal operation.
‡Species unidentifiable under microaerophilic conditions.
§Compared with the type strain of H. cinaedi (CCUG 18818).