28173879 Visualization

A 54 Age - year Age - old Age Asian Personal_background man Sex with IgA History nephropathy History underwent living Detailed_description - donor Detailed_description kidney Therapeutic_procedure transplantation Therapeutic_procedure 14 Date years Date previously Date .
His medical Diagnostic_procedure condition Diagnostic_procedure had been almost Lab_value stable Lab_value for 14 Duration years Duration .
He developed multifocal Detailed_description salmon Color - pink Color skin Biological_structure discoloration Sign_symptom , and swelling Sign_symptom and spontaneous Detailed_description pain Sign_symptom in the left Biological_structure knee Biological_structure and leg Biological_structure .
The symptoms had gradually expanded across the right Biological_structure forearm Biological_structure and outside Biological_structure of Biological_structure the Biological_structure right Biological_structure thigh Biological_structure .
He was admitted Clinical_event to our hospital Nonbiological_location for the evaluation of fever Sign_symptom ( 39 Lab_value °C Lab_value ) and multifocal Detailed_description cellulitis Disease_disorder (Fig.1).
Two Date months Date before Date admission, he had developed chronic Detailed_description diarrhea Sign_symptom .
His serum Diagnostic_procedure creatinine Diagnostic_procedure level was stabilized Lab_value at 1.7 Lab_value mg/dL Lab_value with maintenance immunosuppressive Therapeutic_procedure therapy Therapeutic_procedure comprising tacrolimus Medication ( 3 Dosage mg/day Dosage ), mycophenolate Medication mofetil Medication ( 1500 Dosage mg/day Dosage ), and prednisone Medication ( 4 Dosage mg Dosage every Dosage other Dosage day Dosage ).
The tacrolimus Diagnostic_procedure trough Diagnostic_procedure concentration Diagnostic_procedure was 6.3 Lab_value ng/mL.
The patient had been a Occupation dog Occupation breeder Occupation for Occupation 12 Occupation years Occupation .
On admission, his white Diagnostic_procedure blood Diagnostic_procedure cell Diagnostic_procedure count Diagnostic_procedure was 12,400/μL Lab_value and his C Diagnostic_procedure - reactive Diagnostic_procedure protein Diagnostic_procedure level was 3.9 Lab_value mg/dL.
The patient was initially treated with ampicillin/sulbactam Medication ( 9 Dosage g/day Dosage intravenously Administration ).
Two Date days Date after Date the initiation of this therapy, he was afebrile Sign_symptom .
Four Date days Date later Date , an automated blood Diagnostic_procedure culture Diagnostic_procedure ( Bactec Detailed_description FX® Detailed_description ; Becton Detailed_description – Dickinson Detailed_description and Detailed_description Company, Detailed_description Sparks, Detailed_description MD, Detailed_description USA Detailed_description ) showed positivity Lab_value for gram Diagnostic_procedure - negative Diagnostic_procedure spiral Diagnostic_procedure bacilli Diagnostic_procedure .
A colony Detailed_description obtained Detailed_description from Detailed_description the Detailed_description patient’s Detailed_description blood Detailed_description culture Detailed_description was analyzed by MALDI Detailed_description - TOF Detailed_description MS Diagnostic_procedure ( Biotyper Detailed_description ver. Detailed_description 3.0® Detailed_description ; Bruker Detailed_description Corporation, Detailed_description Germany Detailed_description ).
The identification Lab_value score Lab_value was Lab_value 2.064 Lab_value (>2.0), indicating accurate identification of H. Sign_symptom cinaedi Sign_symptom (Fig.2).
Additional evaluation Diagnostic_procedure of the patient’s blood Biological_structure specifically for H. Sign_symptom
cinaedi Sign_symptom by means of gyrase Detailed_description subunit Detailed_description B Detailed_description (gyrB)-targeted PCR Diagnostic_procedure assays Diagnostic_procedure ( using Detailed_description the Detailed_description forward Detailed_description primer Detailed_description AGGGATTCCACAAAGTGAGC Detailed_description and Detailed_description the Detailed_description reverse Detailed_description primer Detailed_description TCTTGTCCTGTGCGTTCATC Detailed_description to Detailed_description amplify Detailed_description the Detailed_description region Detailed_description of Detailed_description the Detailed_description gyrB Detailed_description gene Detailed_description ) yielded positive Lab_value results.
We performed gyrB Detailed_description - targeted Detailed_description PCR Diagnostic_procedure using a single Detailed_description colony Detailed_description isolated Detailed_description from Detailed_description a Detailed_description blood Detailed_description culture Detailed_description .
We used distilled Detailed_description water Detailed_description (DNA- and Detailed_description DNase Detailed_description - free Detailed_description water) Detailed_description as Detailed_description a Detailed_description negative Detailed_description control Detailed_description to prevent contamination of gyrB-targeted PCR (Fig.3).
In addition, we performed 16S Diagnostic_procedure rRNA Diagnostic_procedure gene Diagnostic_procedure sequencing Diagnostic_procedure of this strain, and the results were > 99% consistent with the existing sequence (Fig.4).
Given these results, we diagnosed the patient with H. Detailed_description
cinaedi Detailed_description bacteremia Disease_disorder with cellulitis Disease_disorder .
We examined Diagnostic_procedure the Diagnostic_procedure genomic Diagnostic_procedure heat Diagnostic_procedure shock Diagnostic_procedure protein Diagnostic_procedure (HSP) Diagnostic_procedure 60 Diagnostic_procedure sequence Diagnostic_procedure of the blood Detailed_description culture Detailed_description isolate Detailed_description , which resulted in identification of cluster Detailed_description B Detailed_description H. Sign_symptom cinaedi Sign_symptom .
A blood Diagnostic_procedure culture Diagnostic_procedure obtained at Date 11 Date days Date was positive Lab_value for H. Diagnostic_procedure
cinaedi Diagnostic_procedure , but a culture Diagnostic_procedure obtained at Date 15 Date days Date was negative Lab_value .
The patient’s cellulitis Disease_disorder gradually resolved.
The patient continued antibiotic Medication treatment for a total of 6 Duration weeks Duration ( ampicillin Medication - sulbactam Medication in a drip Administration for 2 Duration weeks Duration and oral Administration levofloxacin Medication for 4 Duration weeks Duration ), and he had no recurrence Sign_symptom 6 Date months Date after Date this therapy.
His stool Diagnostic_procedure culture Diagnostic_procedure was negative Lab_value , although it was taken Detailed_description after Detailed_description treatment Detailed_description .
We did not apply enteric Medication bacteria Medication elimination Medication in this case.