甘露醇羅爾斯頓氏菌肺炎：案例報告

Ralstonia Mannitolilytica Pneumonia: A Case Report of Rare Opportunistic Pathogen

甘露醇羅爾斯頓氏菌（Ralstonia mannitolilytica）是一種罕見的機會性病原體，與各種感染有關，包括菌血症、中心靜脈導管相關感染、敗血症和骨髓炎。然而，它在引起肺炎方面的作用較少有文獻記錄。我們報告了一例69歲男性的R. mannitolilytica肺炎病例，該患者有哮喘、高血壓、冠狀動脈疾病、主動脈瘤剝離、慢性腎臟病和C型肝炎病毒相關之肝硬化病史。患者在入院前2天出現嚴重腹瀉和低血壓，初步診斷為危及生命的曲狀桿菌（Campylobacter）感染。他接受了抗生素Doripenem治療，然後情況穩定。然而，在住院第6天，發現新的肺炎發作並伴隨呼吸衰竭。從痰樣本中分離出R. mannitolilytica，但並未發現其他病因可以解釋肺炎迅速進展的明確臨床情況。抗生素治療改為levofloxacin之後，患者發燒症狀消退，並且在治療下呼吸困難等症狀得到改善。此後，患者住院期間順利，隨後一系列胸部X光追蹤顯示肺炎有明顯改善。雖然進行了環境調查，但未找到R. mannitolilytica的任何確定來源。這個案例強調了在肺炎病例中考慮R. mannitolilytica作為潛在病原體的重要性，儘管它很罕見，並強調了進一步研究和臨床經驗在管理這種感染中的必要性。

Ralstonia mannitolilytica is a rare opportunistic pathogen associated with various infections, including bacteremia, central venous catheter-associated infections, sepsis, and osteomyelitis. However, its role in causing pneumonia is less welldocumented. We present a case report of R. mannitolilytica pneumonia in a 69-year-old male with a history of asthma, hypertension, coronary artery disease, aortic aneurysm dissection, stage 3 chronic kidney disease, and hepatitis C virusassociated cirrhosis. The patient presented with severe diarrhea and hypotension for two days prior to this admission, which was diagnosed as a life-threatening Campylobacter infection. He was treated with doripenem, and his condition subsequently stabilized. However, on the sixth day of hospitalization, a new episode of pneumonia with respiratory failure was noted. R. mannitolilytica was isolated from a sputum sample, and no other identifiable clinical conditions could account for the rapid progression of pneumonia. The antibiotic treatment was switched to levofloxacin. The patient’s fever subsided and respiratory distress improved with levofloxacin treatment. The patient had a smooth hospital stay thereafter, and a follow-up chest radiograph showed substantial improvement in pneumonic infiltrates and consolidation. Although an environmental survey was conducted, no identifiable source of R. mannitolilytica was found. This case highlights the importance of considering R. mannitolilytica as a potential pathogen in pneumonia cases, despite its rarity, and emphasizes the need for further research and clinical experience in managing this type of infection.