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Rhodococcus equi infections among hospitalized HIV-infected patients in a new infectious disease centre in Malaysia: a2year analysis

Abstract number: R2353

Adnan A., Mohd Nor F., Leong C., Abdul Wahab Z.

Objective:Rhodococcus equi infection has been regarded as an opportunistic infection in immunocompromised hosts. Although the organism is easily cultivated from specimens, it may be misdiagnosed as a contaminant or commmensal due to its diphteroid appearance. The AIDS epidemic has resulted in an increase in awareness on the part of the microbiology laboratory in identifying cases of R. equi infections. A prevalence study of R. equi infections in our 3 year-old institution is presented.

Methodology: Clinically significant isolates of R. equi that were cultured in the Microbiology Laboratory of Sungai Buloh Hospital, Malaysia between January 2008 until October 2009 were included. The laboratory used the Analytical Profile Index (API) system for the identification of the organism. The case files of the patients were reviewed and discussions with the physician were done to determine the clinical significance of the isolates.

Results:R. equi that was deemed clinically significant was isolated from 10 patients over a two-year period (2007–2009). The organism was cultured from blood, sputum and bronchoscopy specimens. All the isolates were recovered from HIV-infected patients. Pneumonia was the main manifestation with fever and productive cough being the presenting complaints. Two patients developed the infections while being treated for underlying pulmonary tuberculosis while another two patients had underlying histoplasmosis. Chest radiographs revealed consolidation (without lobar predilection) and in half of the cases, cavitations were seen. Pleural effusion was not present in any of the cases. The average CD4 lymphocyte count at the time of presentation was 10 cells/ml. All the patients were treated with a combination of vancomycin plus either imipenem or erythromycin. No mortality was seen.

Conclusion: Our observation underlines the importance to suspect R. equi pneumonia in patients with HIV who have low CD4 lymphocytes count (<20 cells//ml) and presence of lung cavities on chest radiograph. The microbiology laboratory plays an important role in the diagnosis of R. equi infection as its diagnosis ultimately relies on the isolation of the organism. A prompt identification and notification helps in the management of the patient.

Session Details

Date: 10/04/2010
Time: 00:00-00:00
Session name: Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Vienna, Austria, 10 - 13 April 2010
Presentation type:
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