Rhodococcus Equi: A Pathogen in Immunocompetent Patients
A 78-year-old female came to surgical OPD with the complaint of pain abdomen and distension since 1 day and fever since 2 days. The patient was apparently normal when she developed pain in abdomen. It was insidious in onset, progressive in nature, throbbing type, with more on the right side, nonradiating, no aggravating or relieving factors were observed. Fever was high grade, insidious in onset, continuous with no variation. No history of vomiting or loose stools was found. She was nondiabetic, nonhypertensive. Her vitals and systemic examination were normal except per abdomen examination showed tender hepatomegaly. Laboratory investigations showed a total count of 18,599 cells/cumm with N 84%, L 13%, Platelet count was 390,000 cells/cumm. ESR was 45 mm at the end of the first hour. Serum total protein level was 5.7 g/dl, serum albumin 2.6 g/dl, serum globulin 3.1 g/dl, A/G ratio 0.8, serum AST 61.0 U/l, serum ALT 51.0 U/l, serum alkaline phosphatase 149.0 U/l. She was nonreactive for HIV and HBsAg.\nAspirate from liver abscess and Bactec blood culture were sent for microbiological investigations. Gram staining of pus showed numerous pus cells but no bacteria. Culture of the pus did not show any growth. The blood culture bottle flagged positive in 48 hours, Salmon-colored colonies grew which were gram positive bacilli and weakly acid-fast by 1% H2SO4. The colony was identified as Rhodococcus equi which was sensitive to ampicillin, amoxicillin-clavulanic acid, cephalosporins, gentamicin, erythromycin, ciprofloxacin. She was treated with ceftriaxone 1.5 g I.V BD for 14 days. She showed remarkable clinical improvement and discharged.