Multifocal Aeromonas Osteomyelitis in a Child with Leukemia

Case Report: A rare infection of multidrug-resistant Aeromonas caviae in a pediatric case with acute lymphoblastic leukemia and review of the literature

Aeromonas caviae infection of the bloodstream and intestine is a rare and severe opportunistic infection in immunocompromised people. In Southwest China, we first reported a case of bloodstream and intestinal infection with multidrug-resistant (MDR) Aeromonas caviae in a 4-year-old child with T-cell acute lymphoblastic leukemia. Blood and stool cultures were used to identify the infection. The selection of antibiotics was based on clinical expertise and medication sensitivity tests. We used linezolid, levofloxacin, and polymyxin B to treat the patient aggressively. Aeromonas caviae infection is uncommon in juvenile acute lymphoblastic leukemia. Doctors should be aware of the likelihood of opportunistic infection during the post-chemotherapy bone marrow suppression period. We further conducted a review of the literature and performed a detailed analysis of Aeromonas infection in pediatric leukemia. It is becoming increasingly apparent that antibiotic is abused domestically and abroad, resulting in the sharp increase of MDR bacteria. In general, most of the Aeromonas isolates are susceptible to third- or fourth-generation cephalosporins, aminoglycosides, quinolones, and carbapenem, but drug-resistant strains are being reported increasingly. We summarized the drug resistance rate of Aeromonas caviae and Aeromonas hydrophila in China in the last 10 years. Early recognition and effective treatment will improve prognosis and reduce mortality.

A case report of a fulminant Aeromonas hydrophila soft tissue infection in a patient with acute lymphoblastic leukemia harboring a rare translocation

INTRODUCTION

Aeromonads are gram-negative opportunistic bacteria, mainly found in aquatic environments. Hematologic patients are particularly at risk of Aeromonas soft tissue infections and septicemia, especially during chemotherapy-induced neutropenia.

CASE DESCRIPTION

A 46-year-old man was diagnosed with acute lymphoblastic leukemia characterized by the rare t(12;17)(p13;q21)/TAF15-ZNF384 aberration. On day 22 of chemotherapy, he developed febrile neutropenia followed by necrotizing fasciitis in his upper right extremity. Despite appropriate antibiotic therapy and prompt surgical intervention, he died within 36 h after the appearance of a fever. A multi-sensitive Aeromonas hydrophila was isolated from all cultural sites.

DISCUSSION AND CONCLUSIONS

In a previous paper we characterized the patient's aberration with cytogenetic and FISH analysis. Here, we provide details regarding the patient's rapidly progressing infection and underline the importance of maintaining high clinical suspicion of Aeromonas infections in acute leukemia. Given the unusually rapid progression of an infection caused by a rare non-resistant pathogen, and after considering data on the implication of metalloproteinase function in immune system regulation, a correlation between risk of severe infection and TAF15-ZNF384 aberrated acute lymphoblastic leukemia cannot be ruled out.

Surgical treatment of recurrent acute lymphoblastic leukemia with humeral osteomyelitis as the first symptom: a case report and literature review

Osteomyelitis is a complication of acute lymphoblastic leukemia (ALL); however, its incidence rate is low. Recurrent ALL for which osteomyelitis is the first manifestation is rarer still. The repair and reconstruction of segmental bone defects caused by infection is a clinical problem. This article reports a rare case study of a 22-year-old male patient with recurrent ALL for which right humeral osteomyelitis was the first symptom including chills at first, recurrent fever and chills then, purulence from poster lateral right upper arm finally. Before treatment, the patient concealed his previous history of ALL. Debridement was performed, and the Masquelet technique and free fibula transplantation were used to reconstruct the humerus. ALL recurred with extensive bone invasion throughout the body 10 weeks after the humeral reconstruction. Despite the success of bone marrow transplantation, the patient died of complications. A limited follow-up period reveled that while leukemia extensively affected the bones of the patient's body, the reconstruction of the humerus was successful, and bone healing was good. This case study suggests that atypical or unexplained osteoarticular infection may be the precursor to some systemic diseases, and that Masquelet technology combined with free fibula transplantation is one of the best choices to treat segmental bone defects.

Chronic osteomyelitis by Aeromonas hydrophila: A silent cause of concern

Aeromonas is a Gram-negative bacillus, widely found in aquatic environment. Osteoarticular pathology caused by Aeromonas hydrophila is rarely encountered. To the best of our knowledge, this is the first case of chronic osteomyelitis by A. hydrophila reported from India. We report a case of chronic osteomyelitis of the lower limb due to A. hydrophila, which occurred as a delayed complication following open reduction and internal fixation. Prompt medical and surgical intervention supplemented by a comprehensive microbiological workup aided in pathogen identification and specific antimicrobial administration resulting in the successful outcome of our patient. This case illustrates the utility of multidisciplinary management approach involving microbiologists and orthopedicians in investigating and appropriately managing such cases.