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Incidental Hafnia alvei Pneumonia in an HIV Positive Patient: A Case Report FREE TO VIEW

Mufadda Hasan, MBChB; Bijoya Goswami, MD; Radheshyam Bhatt, MD; Janaya Raynor, MD; Artur Shalonov, MD; Farshad Bagheri, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Chest. 2014;146(4_MeetingAbstracts):128A. doi:10.1378/chest.1994997
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SESSION TITLE: Infectious Disease Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Patients with HIV infection are at higher risk for infections with unusual microorganisms. Presentation can be atypical. We present an HIV-positive patient who was found to have Hafnia alvei pneumonia after being involved in a motor vehicle accident (MVA).

CASE PRESENTATION: A 53-year-old-man with medical history of HIV, Hepatitis C, hypertension, and diabetes mellitus was brought to the hospital after he sustained MVA. He was stabilized with no significant acute injuries. Vital signs were normal. He had left lower lobe bronchial breath sounds, a small abrasion over the right forehead, and no other pertinent findings. Computerized tomography scan of the chest incidentally revealed patchy infiltrates in the left lower lobe. Prior to the accident, he was experiencing mild left sided chest pain, productive cough with yellowish sputum, and flu-like symptoms for two weeks. Pertinent labs at admission included WBC of 4.5 K/uL and platelets count of 45 K/uL. Broad spectrum antibiotics were started. Subsequently CD4 count was found to be 293 and viral load was 32 copies. Final sputum culture grew Hafnia alvei. Seven days later, repeat chest radiograph showed significant improvement and the patient was discharged home.

DISCUSSION: The pathogenicity of Hafnia alvei has not been well understood. It is a common inhabitant of the gastrointestinal tract. The prevalence of this organism colonization in the tracheobronchial tree remains unknown. However, clinically significant reports of H. alvei pathogenicity have been found in extra-intestinal isolates. H. alvei infections and colonization have been reported in patients with varying degrees of immunosuppression. In our case, with our patinet's background and despite a normal CD4 count, there was an increased chance of pathogenicity of H. alvei. Although the patient had respiratory symptoms for two weeks prior to the accident, his presentation was unusual and his lung infection was discovered incidentally after he sustained MVA.

CONCLUSIONS: Hafnia alvei has been shown to cause serious nosocomial and community acquired infections particularly in patients with immunocompromised state. Treatment should be started promptly on the basis of patient’s clinical symptoms and chest imaging.

Reference #1: JM Janda and SL Abbott. The genus Hafnia: from Soup to Nuts, Clinical Microbiology Reviews. January 2006 p12-18

Reference #2: H Gunthard and A Pennekamp. Clinical significance of extraintestinal Hafnia avei Isolates from 61 patients and review of literature. Clinical Infectious Diseases1996; 22:1040-1045

DISCLOSURE: The following authors have nothing to disclose: Mufadda Hasan, Bijoya Goswami, Radheshyam Bhatt, Janaya Raynor, Artur Shalonov, Farshad Bagheri

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