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Community-Acquired Acinetobacter Pneumonia

1980; Elsevier BV; Volume: 78; Issue: 4 Linguagem: Inglês

10.1378/chest.78.4.670a

1931-3543

M. L. Fdez. Guerrero, J. L. Diaz Fernandez, Jorge Prieto, Jose Luis Gómez Garcés,

Vaccine Coverage and Hesitancy

Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. Communications for this section will be published as space and priorities permit. The comments should not exceed 350 words in length, with a maximum of five references; one figure or table can be printed. Exceptions may occur under particular circumstances. Contributions may include comments on articles published in this periodical, or they may be reports of unique educational character. Specific permission to publish should be cited in a covering letter or appended as a postscript. To the Editor: Acinetobacter calcoaceticus is a nonfermentative Gram-negative bacterium of increasing importance because of its ability to produce a wide variety of infections, including septicemia, urinary tract infections, pneumonia and surgical wound infections.1Glew RH Moellering RC Kunz LJ Infections with Acinetobacter calcoaceticus (Herella vaginicolo): clinical and laboratory studies.Medicine. 1977; 56: 79-97Crossref PubMed Scopus (173) Google Scholar Although most infections occur in hospitalized patients, there are a few cases of community-acquired pneumonia. Recently, Rudin et al2Rudin ML Michael JR Huxley EJ Community acquired Acinetobacter pneumonia.Am J Med. 1979; 67: 39-43Abstract Full Text PDF PubMed Scopus (40) Google Scholar reported six of these cases and in a review the literature found only another six cases. We describe another case of pneumonia with bacteremia and shock that developed in the community. A 32-year-old man was admitted on July 24, 1979 because of acute respiratory disease. His only previous hospitalization was in another hospital in March 1977 for septicemia of E coli and pneumonia. After this, he was well except for occasional lumbosacral pain which irradiated to the legs. Results of outpatient physical, radiologic and laboratory examinations were normal, although a moderate elevation of erythrocyte sedimentation rate was noted. One month before admission to the Jimenez Diaz Foundation, he began to experience lumbosacral pain and was treated with phenylbutazone and methylprednisolone, 8 mg every other day. Three days before admission, he had developed fever, chills, malaise, generalized aches, cough, hemoptoic sputum and chest pain. He was alert, febrile (39°C), hypotensive (80/60 mm Hg), tachycardic and tachypneic. Inspiratory crackles and bronchial breath sounds were heard in both lower lung fields. Smooth hepatomegaly, 3 cm below the right costal margin, was noted. Leukocyte count was 3,600 with 53 percent polymorphonuclear leukocytes. Hemoglobin was 14 g/100 ml An arterial blood sample taken shortly after admission revealed pH 7.46, Po2 53 mm Hg, Pco2 26 mm Hg, CO3H- 18 mEq/L. A chest x-ray film showed alveolar infiltrates in both lower lobes. A sputum specimen and three blood samples were taken for culture and therapy with oxygen, benzylpenicillin, gentamicin, albumin and dextran was started intravenously. The patient improved initially, but remained febrile and over the next hours he developed endotoxic shock, stupor and seizures and died 29 hours after hospitalization. Culture of sputum and three blood cultures taken in the emergency room were positive for Acinetobacter calcoaceticus. Community acquired Acinetobacter calcoaceticus pneumonia is a fulminant disease with high mortality which occurs in patients with chronic disease, especially alcoholism. Patients present acutely ill with pulmonary infiltrates, hypoxemia, leukopenia and shock.2Rudin ML Michael JR Huxley EJ Community acquired Acinetobacter pneumonia.Am J Med. 1979; 67: 39-43Abstract Full Text PDF PubMed Scopus (40) Google Scholar We do not know the underlying disease that led two years ago to the development of pneumonia and septicemia by E coli, in our patient to the persistence of elevated erythrocyte sedimentation rate and now to A calcoaceticus pneumonia, because we did not receive permission for postmortem examination, but it is probable that our patient was an altered host. It is also possible that methylprednisolone treatment helped in the development of infection. Finally, we think that Acinetobacter calcoaceticus must be considered in the differential diagnosis of community acquired pneumonia in a presumed immunocompromised host.