A 42-year-old man, presented to the Medicine Department of our hospital with the complaint of high grade fever, vomiting, yellowish discoloration of sclera, abdominal distension and weakness since last one week. Patient also gave history of pain in abdomen which was usually located in the right hypochondrium and abdominal discomfort since last one month. There was a history of diabetes mellitus type-2 since last two years; he was on antihyperglycaemic medication irregularly. No history of tuberculosis or similar episode in the past and no relevant family history were present. On examination he was conscious, febrile (Temperature-39°C), pulse rate 98/min and blood pressure were 110/88 mmHg. He had pallor and icterus. As per abdominal examination patient had distended abdomen, tenderness in right hypochondrium and epigastrium regions, umbilicus inverted, nodulated vein were seen, itching marks present on lower abdomen and free fluid present, but, abdomen thrill were absent. There was tender hepatomegaly 4cm below the costal margin, but spleen was not palpable. Rest of systemic examination was within normal limit. Laboratory haematological investigation revealed hemoglobin 8.5gm/dl, total leukocytes count 6100/cumm, (polymorphs 74 %, lymphocytes 24%, eosinophil 2 %), Platelets count of 1.5 lacs/cumm, however liver enzymes (SGOT/SGPT-92/65), coagulation profile (PT/PTTK-12.6/27.0) and Alkaline phosphatase were elevated to 958 IU. Renal function and serum electrolytes were within references range.Serology for Hepatitis B surface antigen (HBSAg-7.38 IU/L) was also elevated from the normal reference range. While, serology from HIV and other hepatitis markers (HCV) were non-reactive. Widal test and IgM leptospira were also negative. Ultrasonography of the abdomen showed enlargement of the liver with features suggestive of abscess measuring 8cm×8cm×8.6cm and volume 700CC involving segment VI and VII along with mild ascites. Ultrasound guided liver aspiration was done. About 30ml of pus was aspirated and sent for microbiological investigations, for culture and sensitivity. The pus sample received was processed as per standard microbiological protocol. A wet mount of pus was negative for Trophozoites of Entamoeba histolytica. Ziehl-Nelsen was negative for acid fast bacilli. Direct Gram's stain showed gram negative bacilli along with the pus cells [Table/ Fig-1]. Haemolytic colonies of 2-3mm diameter grew on blood agar and non-lactose fermenting colonies on Mac-Conkey agar. The isolate was identified as A.lwoffii on the basis of biochemical reactions with cytochrome oxidase (negative), oxidative/fermentative glucose (negative), nitrate reduction (negative), and citrate (negative). It was confirmed by automated technique with Vitek-2 system. It was found to be
ABSTRACTAcinetobacter lwoffii is a gram negative aerobic non-fermenter bacilli. It is considered as an important emerging pathogen after Acinetobacter baumannii in patients with impaired immune system and in nosocomial infections. Here, we present a case of community ...