Neumonía bullosa secundaria a Elizabethkingia meningoseptica, su evolución clínica y radiológica

Abstract

Presentación de casos clínicos RESUMENElizabethkingia meningoseptica es un patógeno oportunista, con una elevada mortalidad y una incidencia en aumento en las terapias intensivas. Se presenta a una paciente de 4 años con antecedente de atresia de vías biliares y trasplante hepático a los 11 meses de vida, que se internó por infección respiratoria aguda baja con hipoxemia. Durante la internación, sufrió un empeoramiento clínico con requerimiento de asistencia respiratoria mecánica. Por fiebre e hipoxemia persistente, se realizó un minilavado broncoalveolar, con cultivo positivo para Elizabethkingia meningoseptica. Recibió vancomicina, trimetoprima/sulfametoxazol y ciprofloxacina durante 14 días, con buena respuesta. Una tomografía de tórax evidenció la presencia de hipoperfusión en mosaico, imágenes quísticas y bronquiectasias bilaterales. Durante los siguientes 2 años, presentó una buena evolución clínica, con escasas intercurrencias respiratorias, síntomas intercrisis aislados y buena tolerancia al ejercicio. En las imágenes de control, se evidenció la resolución de la mayoría de las lesiones iniciales a los 20 meses de su seguimiento. ABSTRACTElizabethkingia meningoseptica is an opportunistic pathogen with a high mortality and an increasing incidence in the intensive care units. We present a 4-year-old patient with a history of atresia of the biliary tract and a liver transplant at 11 months of age, who was admitted for acute respiratory infection with hypoxemia. During the hospitalization, she required mechanical ventilation. Neumonía bullosa secundaria a Elizabethkingia meningoseptica, su evolución clínica y radiológicaBullous pneumonia secondary to Elizabethkingia meningoseptica, its clinical and radiological evolution Due to persistent fever and hypoxemia, mini bronchoalveolar lavage was performed with a positive culture for Elizabethkingia meningoseptica. She received vancomycin, trimethoprim/sulfamethoxazole and ciprofloxacin for 14 days with a good response. A chest tomography showed the presence of mosaic hypoperfusion, cystic images, and bilateral bronchiectasis. During the following 2 years, she presented good clinical progress, with scarce respiratory infections, isolated symptoms and good tolerance to exercise. The resolution of the majority of the initial lesions was evidenced at 20 months of follow-up.

Sepsis Caused by Elizabethkingia meningoseptica Successfully Treated by Polymyxin B: A Case Report

“…Elizabethkingia meningoseptica infections are difficult to treat, especially in the ICU. It has been reported that quinolones and vancomycin may be good choices for the treatment of EM infections (12)(13)(14)(15)(16)(17). Our study first confirmed that a polymyxin B-based combination regimen effectively controls sepsis caused by EM complicated by multi-drug resistant P. aeruginosa-associated lung infections, providing new insight for the pharmacotherapy of EM infections, especially mixed infections.…”

“…Although quinolones and vancomycin are effective for EM infections (12)(13)(14)(15)(16)(17), and EM is also sensitive to cefoperazone sulbactam, piperacillin sulbactam, and tigecycline, however, patients in the ICU often have multiple infections. For example, the patient reported here had EM sepsis complicated by a lung infection caused by multi-drug resistant P. aeruginosa.…”