First report of pneumonia and septic shock caused by Cedecea lapagei in Vietnam

Coinfection of Cedecea lapagei and Aspergillus sydowii detected in bronchoalveolar lavage fluid of a patient with pulmonary infection using metagenomic next-generation sequencing: A case report

Background

Cedecea lapagei (C. lapagei), as a potential human pathogen, has been reported in limited cases of human infections in medical literature. However, the increasing frequency of isolating Cedecea lapagei from clinical specimens underscores its growing clinical significance that should not be underestimated. Aspergillus sydowii (A. sydowii), commonly isolated from various environments, serves as a pathogen of human cryptic aspergillosis. Clinical pathological changes caused by A. sydowii are not obvious, posing a significant challenge in clinical diagnosis. Consequently, metagenomic next-generation sequencing (mNGS) are required for precise differentiation and identification of pathogens.

Case description

Here we present a case demonstrating successful treatment outcome in a patient with pulmonary infection caused by coinfection of C. lapagei and A. sydowii, as identified through metagenomic next-generation sequencing. The patient, a 50-year-old male, presented with worsening cough, sputum production, and hemoptysis. Metagenomic next-generation sequencing (mNGS) analysis of the bronchoalveolar lavage fluid (BALF) revealed the presence of both C. lapagei and A. sydowii. Subsequently, C. lapagei was also detected by culture in the same BALF sample, however while clinical fungal cultures and (1-3)-β-D glucan testing yielded negative results. Based on these findings along with imaging features and clinical symptoms of the patient, the final diagnosis was determined to be a co-infection of C. lapagei and A. sydowii.

Conclusion

The clinical manifestations of human infections caused by C. lapagei are not specific; patients with cryptic aspergillosis may have been previously overlooked due to improper specimen selection or negative routine tests. Therefore, precise identification of pathogens is crucial. This case report highlights the value of mNGS in detecting C. lapagei and A. sydowii in BALF, enabling timely diagnosis with coinfections.

Case Report: Cedecea lapagei Infection: Report of a Case in Peru and Review of the Literature

Cedecea lapagei is a gram-negative, non-encapsulated, facultative anaerobic bacterium that has been reported in only a few cases with varying clinical presentations, drug susceptibility, and treatment since its first isolation in 1981. This study aimed to describe a case report of C. lapagei in Peru and systematically review the documented case reports of individuals infected with C. lapagei. A 59-year-old man who had become bedridden with Parkinson's disease and had epilepsy presented with a 1-week history of fever and sore throat and was admitted. Physical examination revealed an obtundation state and abolished vesicular murmur in the right hemithorax. During hospitalization, the patient was diagnosed with various infections, including tuberculosis, for which he received broad-spectrum antibiotics. In the absence of clinical improvement, a urine culture was performed showing C. lapagei (detected by BD Phoenix M50 system, Vernon Hills, IL). The patient received amoxicillin/clavulanate and was discharged. Case reports of C. lapagei were also searched in five databases on January 28, 2023. Twenty cases of C. lapagei were reported worldwide between 2006 and 2022, 16 of which involved adults. Fever was the most common manifestation (75%), and pneumonia was the primary form of presentation (45%). Moreover, 90% of the patients had at least one comorbidity, and 15% died. Also, most of the isolates were sensitive to ciprofloxacin (81%), meropenem (62%), and amikacin (60%). Overall, C. lapagei should be suspected in compromised hosts, particularly those with pneumonia. Although the bacterium can affect various organs and the antibiotic susceptibility pattern is variable, quinolones, tetracyclines, and carbapenems seem to be the first therapeutic option.