Title:E. hirae Causing Biliary Tract Infection in a Patient with
Cholangiocarcinoma: A Case Report
Volume: 23
Issue: 6
Author(s): Neha Sharad, Smriti Srivastava, Aparna Ningombam, Rajesh Malhotra and Purva Mathur*
Affiliation:
- Department of Laboratory Medicine, JPNATC, AIIMS, New
Delhi, India
Keywords:
E. hirae, biliary tract infection, MALDI-TOF, antibiotic resistance, tetracycline, cattle zoonosis.
Abstract:
Introduction: E. faecium and E. faecalis are the common species of Enterococcus responsible
for the majority of infections. Earlier, species other than the common ones were usually unidentified
and reported as Enterococcus species. However, modern equipment, like MALDI-TOF and
VITEK2, have been utilitarian, helping us to identify the previously unidentified species. E. hirae is an
organism seldom reported to cause human infections. Here, we report a case of a biliary tract infection
in a female patient with cholangiocarcinoma caused by E. hirae.
Case: A 56-year-old female presented with fever and abdominal pain. Bile aspirated during the ERCP
was received in our laboratory. The gram stain of the bile sample revealed abundant polymorphonuclear
leucocytes along with gram-positive diplococci. The organism failed to grow on MacConkey agar.
On blood agar, non-hemolytic colonies grew. The organism was identified as E. hirae by MALDI-TOF
MS. The antibiotic susceptibility performed using VITEK2 revealed it to be resistant to high-level
gentamicin and susceptible to all remaining drugs. She was successfully treated with oral ciprofloxacin
for the infection.
Discussion: Bile is colonized with bacteria due to obstruction in the biliary tree, leading to cholangitis.
This causes bacterial proliferation and translocation of bacteria into the systemic circulation. Our case
was resistant to high-level gentamicin, while all previously reported cases were susceptible. The resistant
isolates of E. hirae being isolated from cattle and their surroundings amidst the rampant use of
antibiotics in livestock can pose a difficult situation for humans. Thus, there should be regulations on
antibiotic usage in livestock. Cases like these should be reported and recognized for their potential to
cause outbreaks if they remain unreported.
Conclusion: Thus, E. hirae, when encountered, should not be ignored but considered a pathogen and
reported. The presence of drug-resistant organisms in cattle and their surroundings, their zoonotic potential
to cause infections in humans, and the uncontrolled usage of antibiotics in livestock are causes
for concern. Thus, we need to be more vigilant regarding it in the future.