Volume 20, Number 11—November 2014
Letter
Helicobacter cinaedi Infection of Abdominal Aortic Aneurysm, Japan
Risako Kakuta
, Hisakazu Yano, Hajime Kanamori, Takuya Shimizu, Yoshiaki Gu, Masumitsu Hatta, Tetsuji Aoyagi, Shiro Endo, Shinya Inomata, Chihiro Oe, Koichi Tokuda, Daiki Ozawa, Hitoshi Goto, Yukio Katori, and Mitsuo Kaku
, Hisakazu Yano, Hajime Kanamori, Takuya Shimizu, Yoshiaki Gu, Masumitsu Hatta, Tetsuji Aoyagi, Shiro Endo, Shinya Inomata, Chihiro Oe, Koichi Tokuda, Daiki Ozawa, Hitoshi Goto, Yukio Katori, and Mitsuo Kaku
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).
Page created: October 20, 2014
Page updated: October 20, 2014
Page reviewed: October 20, 2014
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