Species from the genus
A 71-year-old man with diabetes mellitus and dysphagia consequent to a stroke presented with 3 days of productive cough associated with dyspnoea, followed by intermittent altered consciousness. He was admitted to the emergency room with irregular breath pattern and signs of imminent respiratory failure; he required orotracheal intubation and vasoactive support. On admission (Table 1), the laboratory results showed leucocytosis with left-shift neutrophilia, increased creatinine and urea nitrogen levels, uncompensated respiratory acidosis and moderate oxygenation disorder. Chest X-ray and high-resolution computed tomography (HRCT) were requested, showing a consolidation in the upper lobe with involvement of the apical and posterior segments (Figure 1).
High-resolution computed tomography at the second day of hospital stay.
Laboratory Tests
Date | 23/03/17 | 24/03/17 | 25/03/17 | 26/03/17 | 29/03/17 |
---|---|---|---|---|---|
Leucocytes | 13720 | 18400 | 17410 | 14870 | 12850 |
Neutrophils | 86.2% | 86.9% | 83.5% | 84% | 85% |
Lymphocytes | 3.9% | 0.85% | 6.3% | 6.1% | 8.5% |
Haemoglobin | 11.3 | 10.5 | 10.9 | 11.1 | 10.9 |
Haematocrit | 33.4 | 32 | 33.6 | 33 | 27.7 |
Platelets | 174000 | 247000 | 218000 | 234000 | 216000 |
Creatinine | 1.51 | 1.67 | 2.19 | 2.19 | 1.28 |
Blood urea nitrogen | 55.2 | 60.68 | 74.44 | 74.44 | 44.5 |
The patient was thus transferred to the intensive care unit (ICU) with the diagnosis of septic shock with pulmonary origin. Antibiotic management with piperacillin/tazobactam and clarithromycin was initiated. Systemic inflammatory response modulation was observed from the third day of hospitalisation in the ICU. Vasopressor support could be weaned and sedation suspended, and the extubation protocol was started. Bronchoscopy with bronchoalveolar lavage (BAL) was performed with acid fast bacilli and Gram staining, reporting the presence of
There are few reports regarding infection caused by the genus
Risk factors for
As mentioned before, a specific description of a clinical presentation of CAP related to this bacterium could not be found in the literature; however, the clinical and radiological findings and a possible respiratory entry route posed by the isolation of
Regarding the diagnosis and sampling, pneumonia management guidelines consider that samples obtained non-invasively can perform similar to samples obtained using invasive techniques, provided quantitative cultures are correctly interpreted.
Treating infection caused by
The patient in this case received treatment with broad-spectrum antibiotics (piperacillin/tazobactam), considered appropriate for the pneumonia severity criteria according to our institutional guidelines’ recommendations; a favourable evolution was achieved with these antibiotics, even though sensitivity to this antibiotic could not be demonstrated.
The resurgence as pathogens of ubiquitous bacteria that were previously considered only contaminants could be associated with the increased life expectancy of patients with chronic diseases and increased availability of invasive procedures and innovative therapies leading to immunosuppression. It is therefore important not to ignore the presence of bacteria such as the genus
Kocuria pneumonia is a rare infection both in immunosuppressed and immunocompetent individuals; its pathogenic mechanisms and the course of the infection demonstrate the importance of knowing that the timely diagnosis and the start of the antibiotic in the first hours significantly improve the prognosis of the patients as demonstrated in this case.