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Redalyc.Endocarditis Por Bordetella Holmesii En Un Paciente Asplénico

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Redalyc.Endocarditis Por Bordetella Holmesii En Un Paciente Asplénico Revista Argentina de Microbiología ISSN: 0325-7541 [email protected] Asociación Argentina de Microbiología Argentina Soloaga, Rolando N.; Carrion, Natalia A.; Almuzara, Marisa; Barberis, Claudia; Pidone, Juan C.; Guelfand, Liliana I.; Vay, Carlos Endocarditis por Bordetella holmesii en un paciente asplénico Revista Argentina de Microbiología, vol. 45, núm. 2, abril-junio, 2013, pp. 86-88 Asociación Argentina de Microbiología Buenos Aires, Argentina Disponible en: http://www.redalyc.org/articulo.oa?id=213029410004 Cómo citar el artículo Número completo Sistema de Información Científica Más información del artículo Red de Revistas Científicas de América Latina, el Caribe, España y Portugal Página de la revista en redalyc.org Proyecto académico sin fines de lucro, desarrollado bajo la iniciativa de acceso abierto Rev Argent Microbiol. 2013;45(2):86-88 REVISTA ARGENTINA DE MICROBIOLOGÍA www.elsevier.es/ram INFORME BREVE Endocarditis por Bordetella holmesii en un paciente asplénico Rolando N. Soloagaa,*, Natalia A. Carriona, Marisa Almuzarab, Claudia Barberisb, Juan C. Pidonea, Liliana I. Guelfanda y Carlos Vayb aLaboratorio de Microbiología, Hospital Naval «Pedro Mallo», Ciudad Autónoma de Buenos Aires, Argentina bLaboratorio de Bacteriología, Hospital de Clínicas José de San Martín, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina Recibido el 2 de enero de 2013; aceptado el 17 de mayo de 2013 PALABRAS CLAVE Resumen Bordetella holmesii; Se presenta el caso de una paciente de 52 años portadora de estenosis aórtica crítica, Endocarditis; esplenectomizada, hipotiroidea, que tenía como antecedente linfoma de Hodgkin diagnos- Asplenia ticado en 2004. En abril de 2011 ingresó al Servicio de Cardiología por insufi ciencia cardíaca global y registros febriles, con respuesta tórpida al tratamiento diurético-vasodilatador. El ecocardiograma transesofágico mostró imágenes ecodensas en válvulas aórtica, pulmonar y mitral compatibles con vegetaciones, por lo que el cuadro se interpretó como probable endocarditis infecciosa. En dos muestras de hemocultivos desarrolló un cocobacilo gram negativo que fue identifi cado como Bordetella holmesii. Se realizó tratamiento con cef- triaxona 1 g cada 12 h durante 28 días, y se observó una evolución favorable. © 2013 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L. Todos los derechos reservados. Bordetella holmesii endocarditis in an asplenic patient KEYWORDS Bordetella holmesii; Abstract Endocarditis; The case of a 52-year-old female patient with a history of critical aortic stenosis, Asplenia hypothyroidism and splenectomy as treatment for her Hodgkin’s lymphoma is herein presented. In April 2011, the patient was admitted to the cardiology service due to global heart failure, fever and poor response to diuretic and vasodilator therapy. A transesophageal echocardiogram showed images compatible with vegetations in the aortic, pulmonary, and mitral valves. A diagnosis of infective endocarditis was made. Growth of gram- negative coccobacilli was observed in two blood culture sets. The microorganism was fi nally identifi ed as Bordetella holmesii. The patient was treated with ceftriaxone 1 g every 12 hours for 28 days with favorable outcome. © 2013 Asociación Argentina de Microbiología. Published by Elsevier España, S.L. All rights reserved. *Autor para correspondencia. Correo electrónico: [email protected] (R.N. Soloaga). 0325-7541/$ - see front matter © 2013 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L. Todos los derechos reservados. Endocarditis por Bordetella holmesii 87 Bordetella holmesii es un bacilo gram negativo de la familia con angor o equivalentes. Se le dio el alta hospitalaria y Alcaligenaceae. Se caracteriza por ser de crecimiento len- quedó en plan quirúrgico por su estenosis aórtica no grave. to, asacarolítico, con pruebas de oxidasa negativa y catala- Los dos hemocultivos fueron positivos a las 14 h de incu- sa positiva, inmóvil, con exigencias nutricionales y con pig- bación y en la coloración de Gram se observaron cocobaci- mento marrón10,11. los gram negativos. Las botellas fueron subcultivadas en Es un patógeno oportunista con baja virulencia, que se agar tripticasa de soja con 5 % de sangre ovina, en agar encuentra asociado a bacteriemias, endocarditis, celulitis, chocolate y en el medio CLDE. meningitis, infecciones respiratorias y pielonefritis. Por lo A las 48 h de incubación se obtuvo desarrollo de colonias general afecta a pacientes inmunocomprometidos, espe- puntiformes. En agar base Columbia y en agar tripticasa de cialmente a aquellos con asplenia funcional o anatómica, o soja, las colonias mostraron un ligero pigmento marrón di- con otras enfermedades como sida, EPOC, insufi ciencia re- fusible. El aislamiento en agar tirosina mostró la producción nal crónica y artritis reumatoidea1-4,6,8-10,13. de este pigmento con mayor intensidad. Las pruebas de hi- Se ha aislado Bordetella holmesii de la nasofaringe de drólisis de urea, oxidasa, movilidad y reducción de nitratos pacientes que presentaban un cuadro similar al de la tos fueron negativas. La cepa desarrolló en agar MacConkey, convulsa producida por Bordetella pertussis. Sin embargo, pero no produjo β-hemólisis en el agar Columbia con 5 % de la transmisión entre humanos no ha sido aún claramente sangre de carnero. dilucidada5,7,9,14. La identifi cación fenotípica se realizó acorde con los es- Se presenta el caso de una paciente de 52 años portado- quemas de pruebas previamente descritos10,11 y con tarjetas ra de estenosis aórtica crítica, esplenectomizada, hipoti- Vitek 2 (bioMèrieux) Neisseria-Haemophilus (NH) y bacilos roidea, que presentó como antecedente linfoma de gram negativos (GN), respectivamente, siguiendo las ins- Hodgkin diagnosticado en 2004, el cual se trató con qui- trucciones del fabricante. Los resultados de las pruebas con- mioterapia y radioterapia; también presentaba pericar- vencionales coincidieron con los consignados para Bordetella ditis actínica y mediastinitis contractiva, razón por la cual holmesii (tabla 110,11). Los resultados de la identifi cación me- en mayo de 2009 se le realizó una valvuloplastia aórtica. diante el Sistema Vitek 2 fueron los siguientes: Neisseria En diciembre de 2010 desarrolló edema agudo de pulmón sicca/Oligella urethralis (baja discriminación) con la tarjeta secundario a sobrecarga por volumen. NH y Comamonas testosteroni con la tarjeta GN; sin embar- En abril de 2011 ingresó al Servicio de Cardiología por go, hay que resaltar que B. holmesii no se encuentra en la insufi ciencia cardíaca global, con respuesta tórpida al tra- base de datos de ninguna de las dos tarjetas. tamiento diurético-vasodilatador. Debido a registros febri- Se realizó la secuenciación del gen 16S ARNr para contri- les de 38 ºC se realizaron dos hemocultivos en botellas FAN buir con la identifi cación del microorganismo aislado; su aeróbicas del Sistema Bact-Alert (bioMèrieux, Marcy, amplifi cación se efectuó mediante el uso de los cebadores l´Etoile, Francia) y se enviaron al Servicio de Bacteriología descritos por Weisburg et al.14. Se utilizó Taq DNA polimera- para su incubación. sa de acuerdo a las especifi caciones del fabricante (Prome- Se realizó un ecocardiograma transesofágico en el que se ga). La secuenciación del ADN fue realizada con un Bioana- evidenciaron imágenes ecodensas en válvulas aórtica, pul- lizador ABIPrism 3100 (Universidad de Utah, EE. UU.). monar y mitral, compatibles con vegetaciones. Se interpre- La secuencia fue comparada con aquellas secuencias de- tó el cuadro como endocarditis infecciosa y se realizó trata- positadas en la base de datos de GenBank usando el soft- miento con ceftriaxona 1 g cada 12 h durante 28 días. La ware Blast V 2.0 (http://www.ncbi.nlm.nih.gov/BLAST/). paciente evolucionó de manera favorable, sin fi ebre, esta- Este análisis reveló un 99 % de identidad con Bordetella ble hemodinámicamente, sin sintomatología compatible holmesii (accesion number DQ409136). Este resultado no Tabla 1 Perfi les bioquímicos diferenciales de Bordetella pertussis, Bordetella holmessi, Bordetella parapertussis y especies asacarolíticas de Acinetobacter13 Prueba Resultadoa B. pertussis B. holmessi B. parapertussis Acinetobacter spp. Oxidasa + −−− Movilidad ND −−− Pigmento − Marrón difusible Marrón difusible V Agar TSIb K/n K/n K/n K/n Ureasa −−+ − Nitrato reductasa ND −−− β-hemólisis + (81 %) − +V Agar MacConkey − +++ ND: no determinado; V: variable. aK/n: alcalino/neutro; bagar TSI: agar hierro triple azúcar. 88 R.N. Soloaga et al permite discriminar confi ablemente entre B. holmesii Bibliografía y Bordetella parapertussis, tampoco entre B. holmesii y B. pertussis o Bordetella bronchiseptica8,13; sin embargo, el 1. Barrado L, Barrios M, Sanz F, Chaves F. Bacteriemia por crecimiento en agar MacConkey, la prueba de oxidasa nega- Bordetella holmessi en una niña con anemia falciforme. Enferm tiva, la presencia de pigmento marrón en el agar tirosina y Infecc Microbiol Clin. 2011; 29: 778-86. la ausencia de β-hemólisis observada en agar sangre ayudan 2. Bush LM, Davidson EB, Daughart J. Bordetella holmesii prosthetic valve endocarditis: a case report and review. Infect a diferenciar B. holmesii de B. pertussis. Los resultados ne- Dis Clin Pract. 2012; 20: 248-53. gativos en las pruebas de producción de oxidasa y ureasa, 3. Guthrie JL, Robertson AV, Tang P, Jamieson F, Drews SJ. Novel de reducción de nitratos y de movilidad diferencian a esta duplex real-time PCR assay detects
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