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A Case of Community Acquired Pneumonia Caused by Hafnia alvei Developing Into an Empyema FREE TO VIEW

Mohana Krishna Loya, MD; James Walsh, MD
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Guthrie Robert Packer Hospital, Sayre, PA

Chest. 2015;148(4_MeetingAbstracts):101A. doi:10.1378/chest.2223426
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SESSION TITLE: Chest Infections I Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Hafnia alvei, formerly known as Enterobacter hafniae, is a gram negative facultative anaerobe that belongs to the family Enterobacteriaceae. Hafnia alvei is a commensal organism in the human digestive tract and is rarely considered to be pathogenic in immunocompetent individuals (1).

CASE PRESENTATION: A 95 year old Caucasian woman with a history of Chronic kidney disease stage 3b, Hypertension and Bonnet syndrome presented with two days of yellow colored productive cough and one day of chills, rigors and shortness of breath. Upon evaluation patient was found to be febrile (101.9 F), tachycardic (heart rate of 120), tachypneic (respiratory rate of 32), hypoxic (requiring 4 liters of oxygen to maintain saturations more than 92%) and normotensive (BP 124/62). Laboratory evaluation showed leukocytosis (38,900) and chest X ray imaging showed right lower lung field opacification. The patient was started on Piperacillin/ Tazobactam and Azithromycin antibiotics. The patient's clinical condition improved initially but significant respiratory distress developed the next day. Repeat chest XR imaging showed extension of right lower lung field opacification to the mid thorax. Emergent right sided thoracentesis was done at the bed side which drained 200 ml of purulent discharge with a PH less than 6.790. Antibiotic coverage was broadened to Vancomycin, Piperacillin/ Tazobactam and Ciprofloxacin. The patient underwent emergent video-assisted thoracoscopy with drainage and debridement of empyema cavity and a partial decortication. Thoracentesis pus discharge grew Hafnia alvei, which was sensitive to Ciprofloxacin. The patient completely recovered from the illness after receving a 4 week course of antbiotics.

DISCUSSION: Hafnia alvei is a commensal organism in the human digestive tract and is rarely considered to be pathogenic in immunocompetent individuals (1). Hafnia alvei has been reported to cause pneumonia (1), bacteremia (1), endocarditis, meningitis (1) and abscesses (1). And there have been case reports of Hafnia alvei nosocomial pneumonia (2) or Hafnia alvei pneumonia in Human Immunodeficiency Virus infected patients (3).

CONCLUSIONS: To our knowledge, we present the first case report of community acquired pneumonia caused by Hafnia alvei developing into an empyema in a patient with no significant underlying illness.

Reference #1: 1. Clinical significance of extraintestinal Hafnia alvei isolates from 61 patients and review of the literature. Clin Infect Dis. 1996 Jun;22(6):1040-5. Günthard H, Pennekamp A.

Reference #2: 2. Nosocomial pneumonia caused by Hafnia alvei. An Med Interna. 2003 Nov;20(11):595-6. Millán Rodríguez MR, Muñoz Pérez MA, Meseguer Frutos MD, Cano Sánchez A, Román López Andreu F, Soriano Palao J.

Reference #3: 3. A Pneumonia caused by Hafnia alvei in a patient infected with human immunodeficiency virus. Enferm Infecc Microbiol Clin. 2001 Jan;19(1):41-2. Galeas F, de la Torre FJ, Prada JL, del Arco A

DISCLOSURE: The following authors have nothing to disclose: Mohana Krishna Loya, James Walsh

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