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首页> 外文期刊>The Internet Journal of Infectious Diseases >Brevundimonas Vesicularis Bacteremia Following Allogeneic Bone Marrow Transplantation
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Brevundimonas Vesicularis Bacteremia Following Allogeneic Bone Marrow Transplantation

机译：同种异体骨髓移植后的Brevundimonas Vesicularis细菌血症

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Bacterial infection and sepsis is a major cause of morbidity and mortality after hematopoietic stem cell transplantation. We report a case of Brevundimonas vesicularis bacteremia in a patient following mismatched related donor peripheral blood stem cell transplantation (PBSCT). Case Report The patient was a 36 year-old African American woman with a two year history of acute myelogenous leukemia (AML). She was initially treated with an induction chemotherapy regimen of Idarubicin and Ara-C with only a partial response. She required a second course of chemotherapy with the same agents to achieve a complete remission. She received two additional courses of consolidation chemotherapy with high dose Ara-C after achieving full remission to maintain her in remission for 7 months. At that point a bone marrow biopsy with flow cytometry revealed evidence of recurrent disease. Autologous PBSCT was considered due to lack of an allogeneic marrow donor. Autologous PBSCT was performed following standard conditioning with Busulfan and Cytoxan. Recurrence of AML was detected 6 months after autologous PBSCT and she underwent salvage chemotherapy with Etoposide and Mitoxantrone. One month later, she was in morphological remission but the cytogenetic analysis of the bone marrow was positive. Mismatched related donor PBSCT was performed. After her pancytopenia resolved she was discharged home. She was readmitted 45 days post transplant for evaluation of fever and cough of one day duration. On examination she was in respiratory distress with a respiratory rate of 30/min, temperature of 103°F, heart rate of 120 beats/min and a blood pressure of 75/40 mm Hg. Chest auscultation revealed bilateral diffuse crackles. Cardiac, abdominal and neurological examination was unremarkable. There were no indwelling intravascular devices. Two sets of blood cultures were obtained and she was started on empiric broad spectrum antimicrobial coverage including Vancomycin, Meropenem, Amikacin, Amphotericin B and Gancyclovir. The initial chest radiograph showed bilateral diffuse bilateral air-space opacities (Figure 1a). She developed severe hypoxemic respiratory failure requiring intubation and mechanical ventilation. She required vasopressor therapy for hypotension unresponsive to fluid resuscitation. A diagnosis of Septic Shock and Acute Respiratory Distress Syndrome (ARDS) was made. Repeat chest radiograph showed progression of her bilateral parenchymal infiltrates (Figure 1b).
机译：细菌感染和败血症是造血干细胞移植后发病和死亡的主要原因。我们报告了不匹配的相关供体外周血干细胞移植（PBSCT）后患者中的Brundundimonas vesicularis菌血症的情况。病例报告该患者是一名36岁的非洲裔美国妇女，有两年的急性骨髓性白血病（AML）病史。最初使用伊达比星和Ara-C的诱导化疗方案治疗了她，但仅部分缓解。她需要使用相同的药物进行第二轮化疗，以实现完全缓解。在完全缓解以维持7个月的缓解后，她又接受了两个疗程的大剂量Ara-C巩固化疗。在那时，通过流式细胞术进行的骨髓活检显示了疾病复发的证据。由于缺乏同种异体骨髓供体，因此考虑了自体PBSCT。在用白消安和Cytoxan进行标准条件处理后，进行自体PBSCT。自体PBSCT治疗6个月后发现AML复发，她接受了依托泊苷和米托蒽醌的挽救性化疗。一个月后，她处于形态缓解期，但骨髓的细胞遗传学分析为阳性。进行了不匹配的相关供体PBSCT。全血细胞减少症解决后，她出院了。移植后45天重新入院，以评估发烧和持续1天的咳嗽情况。经检查，她处于呼吸窘迫状态，呼吸频率为30 / min，温度为103°F，心律为120次/ min，血压为75/40 mm Hg。胸部听诊发现双侧弥漫性裂纹。心脏，腹部和神经系统检查无异常。没有留置血管内装置。获得了两组血液培养物，并开始进行经验性广谱抗菌药物覆盖，包括万古霉素，美洛培南，阿米卡星，两性霉素B和更昔洛韦。最初的胸部X光片显示双侧弥漫性双侧气隙混浊（图1a）。她出现严重的低氧血症性呼吸衰竭，需要插管和机械通气。她需要对血管复苏无反应的低血压进行升压治疗。诊断为败血性休克和急性呼吸窘迫综合症（ARDS）。复查胸部X线片显示其双侧实质浸润进展（图1b）。

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