A case of Aeromonas hydrophila septicemia in a patient with monocytic leukemia (author's transl)

Abstract

A 64-year-old man with monocytic leukemia for the past two years was admitted for general fatigue on April 20, 1978. On admission he was afebril and had slight anemia, knock pain at lower sternum and hepatomegaly. Laboratory data showed WBC 20, 600/mm3 with 30% leukemic cells, erythroblast 800/mm3, bleeding time 8 minutes, and erythrocyte sedimentation rate 68 mm in one hour. He was recieved Daunomycin, Cytosine arabinoside, 6-Mercaptopurine and Prednisolone without remission. Prednisolone was continued throughout his hospitalization, because he had had persistent granulocytopenia less than 500/mm3 since August 1978.On November 25, he became febrile with spiking temperature of 37-39 °C, and complained of right hypochondral pain. Laboratory data showed WBC 97/mm3, Alkaline phosphatase 38.5 KAu, γ-GTP 196 u and LAP 76 u. On these findings liver abscess was suspected, and chemotherapy of Cephalothin was started. From the blood culture on the next day, an oxidase-positive, glucosefermentative Gram negative rod, later identified as Aeromonas hydrophila, was purely isolated. The organism was sensitive to Chloramphenicol, Tetracycline, Minocycline, Kanamycin, Gentamicin, Tobramycin and Nalidixic acid, and resistant to Ampicillin, Carbenicillin, Cephalothin, Cephaloridine and Colistin. Therefore, Cephalothin was discontinued, and Tobramycin and Minocycline were started on the basis of antibiotic susceptibility. After a week he becamed afebril, but deteriorated gradually, and expired on January 13, 1979. Postmortum examination revealed left thoracic empyema and abscess formation in the liver and the spleen. From these abscess contents Aeromonas hydrophila was isolated again.Associated with the use of immunosuppressive agents and antibiotics, infections due to various organisms that are not common human pathogens are increasing nowadays. Aeromonas hydrophila has been recently recognized as an opportunistic pathogen.