Letter to the Editor
Empyema due to Aggregatibacter aphrophilus and Parvimonas micra Coinfection
Empiema secundario a coinfección por Aggregatibacter aphrophilus y Parvimonas micra
a Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), SERGAS, A Coruña, Spain
b Servicio de Microbiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), SERGAS, A Coruña, Spain
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"apellidos" => "Marcos" "email" => array:1 [ 0 => "pedro.jorge.marcos.rodriguez@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), SERGAS, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Complejo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), SERGAS, A Coruña, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Empiema secundario a coinfección por <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> y <span class="elsevierStyleItalic">Parvimonas micra</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 992 "Ancho" => 1500 "Tamanyo" => 175984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Upper and lower right lobe infiltrates and pleural effusion; (b) right lower lobe atelectasis with pleural effusion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span>, formerly known as <span class="elsevierStyleItalic">Haemophilus aphrophilus</span>, is a facultative anaerobic Gram-negative coccobacillus that forms part of the oropharyngeal flora. Although it is not highly pathogenic, it has been associated with infections, such as endocarditis, cerebral abscesses, bone and joint infections, and endophthalmitis.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">1,2</span></a> Pleuropulmonary involvement, however, remains exceptional.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a> Another common commensal of the oropharyngeal cavity is <span class="elsevierStyleItalic">Parvimonas micra</span>, formerly <span class="elsevierStyleItalic">Peptostreptococcus micros</span>, a strictly anaerobic Gram-positive coccus that has been associated with polymicrobial infections (intracranial abscesses, paranasal sinus infections, periodontitis and septic embolism<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">4,5</span></a>). Reports of <span class="elsevierStyleItalic">P. micra</span> as a pathogen in lung infections are exceedingly rare. We report the first case of pleural empyema due to <span class="elsevierStyleItalic">A. aphrophilus</span> and <span class="elsevierStyleItalic">P. micra</span> coinfection.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 49-year-old man was admitted with a 4-day history of dyspnea, cough with purulent expectoration and fever. In the previous 3 months, he had suffered asthenia and anorexia and had lost 12<span class="elsevierStyleHsp" style=""></span>kg in weight. He was a habitual smoker (1 pack-year) and his alcohol intake was 80<span class="elsevierStyleHsp" style=""></span>g ethanol/day. He had no other comorbidities. On physical examination, temperature was 37.4<span class="elsevierStyleHsp" style=""></span>°C, hypoventilation in the lower half of the right hemithorax on lung auscultation, and poor oral hygiene, with extensive caries and evidence of periodontitis. Clinical laboratory results revealed a white blood cell count of 13.6×10<span class="elsevierStyleSup">9</span>/l (normal values [NV]: 4–11.5×10<span class="elsevierStyleSup">9</span>/l) with neutrophilia, hemoglobin 10.4<span class="elsevierStyleHsp" style=""></span>g/dl (NV: 13–18<span class="elsevierStyleHsp" style=""></span>g/dl) and hematocrit 32.8% (NV: 41%–50%), 959×10<span class="elsevierStyleSup">9</span>/l (NV: 130–450×10<span class="elsevierStyleSup">9</span>/l) platelets and erythrocyte sedimentation rate (ESR) 110<span class="elsevierStyleHsp" style=""></span>mm/h (NV: <20<span class="elsevierStyleHsp" style=""></span>mm). Chest X-ray on admission showed parenchymal infiltrations in the posterior segment of the right upper lobe and apical region of the right lower lobe, with loss of volume and right pleural effusion (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>a). Thoracocentesis was performed, and purulent fluid was obtained that was sent for culture. Wide-spectrum antibiotic treatment with linezolid and imipenem began and a chest tube was placed, to which fibrinolytics were added: 1500<span class="elsevierStyleHsp" style=""></span>cc of purulent fluid was drained. Chest computed tomography (CT) was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>b), showing pulmonary infiltrate, pleural and atelectasis of the lung. Mixed flora were identified on a direct Gram stain of the specimen. Culture of the pleural fluid was positive for <span class="elsevierStyleItalic">A. aphrophilus</span> and <span class="elsevierStyleItalic">P. micra</span>, as identified by mass spectronomy (MALDI-TOF). On the basis of these results, the antibiotic treatment was scaled down to amoxicillin–clavulanate, which continued for 4 weeks. The patient's progress was satisfactory with clear improvement of the clinical picture.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Pleuropulmonary infections by <span class="elsevierStyleItalic">A. aphrophilus</span> are uncommon; indeed, since 1965 only 3 cases have been reported.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">2,3,6</span></a> Our case is particularly unusual, due to the concomitant isolation of <span class="elsevierStyleItalic">P. micra</span>: an extensive search of the literature revealed only 1 case in which this microorganism was described as a causative agent of empyema.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> This is the first report of such a case in Spain.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The initial presentation, radiological pattern and clinical course of our case are indistinguishable from infections caused by other microorganisms. The patient had a history of general decline over several months, along with predisposing factors, such as alcohol abuse and periodontal disease. He responded to standard antibiotic treatment, chest drainage and fibrinolytics.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To conclude, although <span class="elsevierStyleItalic">A. aphrophilus</span> and <span class="elsevierStyleItalic">P. micra</span> may be exceptional, they should be considered as causative agents of pleural infection, particularly in patients with risk factors. The presentation, clinical management and clinical course were no different from empyema caused by more common microorganisms.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodriguez-Segade S, Velasco D, Marcos PJ. Empiema secundario a coinfección por <span class="elsevierStyleItalic">Aggregatibacter aphrophilus</span> y <span class="elsevierStyleItalic">Parvimonas micra</span>. Arch Bronconeumol. 2015;51:254–255.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 992 "Ancho" => 1500 "Tamanyo" => 175984 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Upper and lower right lobe infiltrates and pleural effusion; (b) right lower lobe atelectasis with pleural effusion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification, identification, and clinical significance of <span class="elsevierStyleItalic">Haemophilus</span> and <span class="elsevierStyleItalic">Aggregatibacter</span> species with host specificity for humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 1 | 4 |
| 2024 October | 47 | 21 | 68 |
| 2024 September | 44 | 29 | 73 |
| 2024 August | 64 | 46 | 110 |
| 2024 July | 51 | 29 | 80 |
| 2024 June | 63 | 30 | 93 |
| 2024 May | 62 | 59 | 121 |
| 2024 April | 43 | 29 | 72 |
| 2024 March | 56 | 24 | 80 |
| 2024 February | 34 | 15 | 49 |
| 2023 April | 0 | 1 | 1 |
| 2023 March | 8 | 1 | 9 |
| 2023 February | 52 | 30 | 82 |
| 2023 January | 50 | 44 | 94 |
| 2022 December | 70 | 50 | 120 |
| 2022 November | 92 | 44 | 136 |
| 2022 October | 79 | 40 | 119 |
| 2022 September | 58 | 34 | 92 |
| 2022 August | 108 | 47 | 155 |
| 2022 July | 53 | 39 | 92 |
| 2022 June | 58 | 46 | 104 |
| 2022 May | 66 | 41 | 107 |
| 2022 April | 68 | 45 | 113 |
| 2022 March | 74 | 41 | 115 |
| 2022 February | 57 | 52 | 109 |
| 2022 January | 56 | 64 | 120 |
| 2021 December | 46 | 36 | 82 |
| 2021 November | 43 | 54 | 97 |
| 2021 October | 59 | 36 | 95 |
| 2021 September | 43 | 46 | 89 |
| 2021 August | 29 | 35 | 64 |
| 2021 July | 49 | 43 | 92 |
| 2021 June | 26 | 50 | 76 |
| 2021 May | 65 | 35 | 100 |
| 2021 April | 175 | 137 | 312 |
| 2021 March | 75 | 20 | 95 |
| 2021 February | 58 | 26 | 84 |
| 2021 January | 48 | 26 | 74 |
| 2020 December | 28 | 26 | 54 |
| 2020 November | 43 | 15 | 58 |
| 2020 October | 59 | 18 | 77 |
| 2020 September | 48 | 21 | 69 |
| 2020 August | 49 | 16 | 65 |
| 2020 July | 36 | 46 | 82 |
| 2020 June | 40 | 5 | 45 |
| 2020 May | 40 | 17 | 57 |
| 2020 April | 52 | 33 | 85 |
| 2020 March | 31 | 17 | 48 |
| 2020 February | 46 | 21 | 67 |
| 2020 January | 61 | 22 | 83 |
| 2019 December | 76 | 22 | 98 |
| 2019 November | 38 | 18 | 56 |
| 2019 October | 28 | 10 | 38 |
| 2019 September | 45 | 11 | 56 |
| 2019 August | 43 | 20 | 63 |
| 2019 July | 48 | 24 | 72 |
| 2019 June | 70 | 25 | 95 |
| 2019 May | 50 | 20 | 70 |
| 2019 April | 46 | 28 | 74 |
| 2019 March | 61 | 21 | 82 |
| 2019 February | 43 | 22 | 65 |
| 2019 January | 44 | 24 | 68 |
| 2018 December | 48 | 16 | 64 |
| 2018 November | 76 | 21 | 97 |
| 2018 October | 100 | 26 | 126 |
| 2018 September | 33 | 11 | 44 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 22 | 0 | 22 |
| 2018 April | 50 | 8 | 58 |
| 2018 March | 89 | 5 | 94 |
| 2018 February | 42 | 9 | 51 |
| 2018 January | 83 | 7 | 90 |
| 2017 December | 55 | 10 | 65 |
| 2017 November | 27 | 4 | 31 |
| 2017 October | 20 | 6 | 26 |
| 2017 September | 24 | 10 | 34 |
| 2017 August | 37 | 36 | 73 |
| 2017 July | 19 | 9 | 28 |
| 2017 June | 32 | 10 | 42 |
| 2017 May | 43 | 6 | 49 |
| 2017 April | 27 | 8 | 35 |
| 2017 March | 27 | 12 | 39 |
| 2017 February | 33 | 7 | 40 |
| 2017 January | 23 | 4 | 27 |
| 2016 December | 40 | 10 | 50 |
| 2016 November | 53 | 14 | 67 |
| 2016 October | 53 | 24 | 77 |
| 2016 September | 65 | 20 | 85 |
| 2016 August | 46 | 9 | 55 |
| 2016 July | 48 | 20 | 68 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 44 | 1 | 45 |
| 2015 September | 36 | 12 | 48 |
| 2015 August | 42 | 24 | 66 |
| 2015 June | 0 | 1 | 1 |
| 2015 April | 3 | 0 | 3 |
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