PURPOSE: To report a case of bacterial keratitis caused by Hafnia alvei after using a contact lens in a patient with graft-versus-host disease. CASE SUMMARY: A 47-year-old male patient presented with a corneal ulcer. The patient had been wearing a therapeutic contact lens for a month because of severe dry eye syndrome and filament removal due to filamentary keratitis. The patient had been taking moxifloxacin to prevent infection, but had not for the previous 7 days. The corneal ulcer occurred at the 11 o'clock direction in the peripheral cornea accompanied by corneal epithelial defect and stromal infiltration. The corneal scraping and culture yielded Hafnia alvei, which is susceptible to ceftazidime, levofloxacin and moxifloxacin. There was no systemic signs or symptoms to suspect systemic infection. After treatment with a topical antibiotic agent, the patient's eye condition improved with only mild corneal opacity remaining. CONCLUSIONS: Hafnia alvei infection rarely occurs in humans but should be considered as a potential causal pathogen in immunosuppressed patients.
Aza Compounds ; Ceftazidime ; Cornea ; Corneal Opacity ; Corneal Ulcer ; Dry Eye Syndromes ; Eye ; Graft vs Host Disease ; Hafnia ; Hafnia alvei ; Humans ; Keratitis ; Male ; Middle Aged ; Ofloxacin ; Quinolines

Hafnia alvei is gram-negative bacilli that is rarely isolated from human specimens and is rarely considered to be pathogenic. It has been associated with gastroenteritis, pneumonia, meningitis, bacteremia, and nosocomial wound infections. But, no case of extraintestinal H. alvei infection was documented in Korea to our knowledge. A 50-year-old man with hepatocellular carcinoma was admitted to our hospital via emergecy department because of abdominal pain. The peritoneal fluid and 3 consecutive blood cutures yielded H. alvei. The organism was susceptible to all antimicrobial agents tested, except cefazolin. Despite treatment with intravenous cefotaxime, the patient was expired after 4 days due to septicemia.
Abdominal Pain ; Anti-Infective Agents ; Ascitic Fluid ; Bacteremia ; Carcinoma, Hepatocellular ; Cefazolin ; Cefotaxime ; Gastroenteritis ; Hafnia alvei* ; Hafnia* ; Humans ; Korea ; Meningitis ; Middle Aged ; Peritonitis* ; Pneumonia ; Sepsis* ; Wound Infection

Hafnia alvei is a Gram-negative rod that is rarely isolated from human specimens and is rarely pathogenic. It has been associated with gastroenteritis, pneumonia, urinary tract infection, bacteremia, and nosocomial wound infection, but extra-intestinal H. alvei infection is very rare. We present a case of biliary sepsis caused by H. alvei. A 42-year-old woman was admitted with abdominal pain and jaundice. She was diagnosed with metastatic cholangiocarcinoma and received conservative treatment. Six days later, hyperbilirubinemia and signs of sepsis developed and H. alvei was isolated from both the bile and blood. Despite treatment with antibiotics the organism was sensitive to (it was documented as susceptible to piperacillin/tazobactam and ciprofloxacin in sensitivity tests), the patient's condition grew worse. The antibiotics were switched to meropenem and the biliary sepsis was resolved.
Abdominal Pain ; Adult ; Anti-Bacterial Agents ; Bacteremia ; Bile ; Cholangiocarcinoma ; Ciprofloxacin ; Female ; Gastroenteritis ; Hafnia ; Hafnia alvei ; Humans ; Hyperbilirubinemia ; Jaundice ; Pneumonia ; Sepsis ; Thienamycins ; Urinary Tract Infections ; Wound Infection

Hafnia alvei is a gram-negative bacillus that is rarely isolated from human clinical specimens and is rarely pathogenic. This organism is an extremely uncommon cause of spontaneous bacterial peritonitis (SBP). We report a case of an 83-year-old male with hepatitis C-associated liver cirrhosis and hepatocellular carcinoma who was diagnosed with SBP caused by H. alvei. He was admitted to an university-affiliated hospital with fever and abdominal pain. There were 2 episodes of SBP during 2 months. Although isolates of H. alvei from ascitic fluid were shown to be susceptible to cefotaxime, responses for cefotaxime treatment were inadequate in both episodes. Therefore, cefotaxime was switched to imipenem in the first episode and to ciprofloxacin in the second, according to the results of antimicrobial susceptibility. After the antibiotics was changed, SBP was resolved.
Abdominal Pain ; Aged, 80 and over ; Anti-Bacterial Agents ; Ascitic Fluid ; Bacillus ; Carcinoma, Hepatocellular ; Cefotaxime ; Ciprofloxacin ; Fever ; Hafnia ; Hafnia alvei ; Hepatitis ; Humans ; Imipenem ; Liver ; Liver Cirrhosis ; Male ; Peritonitis