Decompensated liver cirrhosis as a risk factor for E. cecorum sepsis - the link between veterinary pathogens and human disease

• Published in: Acta clinica belgica (English ed. Online) Vol. 71; no. S1; p. 20
• Main Authors: Pang, Kin Wing, Coorevits, Liselotte, Van Acker, Jos, Pauwels, Walter
• Format: Journal Article
• Language: English
• Published: Ghent Taylor & Francis Ltd 01.01.2016
• Subjects: Bacterial infections; Infections; Liver cirrhosis; Penicillin; Phylogenetics; Sepsis
• ISSN: 1784-3286; 2295-3337

Enterococcus cecorum is a pathogen rarely involved in human infections. The rarity of these infections can be explained by the fact that E. cecorum is difficult to identify correctly and has probably been underestimated in the past. We report a case of a 78-year old man with underlying liver cirrhosis diagnosed with E. cecorum sepsis, who was successfully treated with a cephalosporin of third generation (C3). Flight Mass Spectrometry (MALDI-TOF®) was used to identify the pathogen and confirmed by 16S rDNA sequencing. In addition, we review previous cases withholding a common risk factor. Remarkably, half of the cases, including our case, had underlying decompensated liver cirrhosis. Meat-mediated origin has been hypothesized as the source of infection (ingestion of colonized poultry meat), impairment of neutrophil function by PPIs has been reported (increasing the risk of bacterial infection in this case) and difference in penicillin-binding proteins (due to phylogenetic difference) than those from other Enterococci species (E. faecaüs and E. faecium) make this pathogen susceptible for ceftriaxone. In conclusion, underlying decompensated liver cirrhosis and use of PPI may constitute an important risk factor for an E. cecorum infection in humans. The isolation and identification of this species remains a challenge. Phylogenetic differences of species has an impact of AB choice due to differences in AB resistance. Surveillance of veterinary pathogens, especially when it comes to bacterial resistance, might be more important in the near future, particularly with the upcoming patients with a state of immune-deficiency and in the context of bacterial pathogens that (might) play a role in both humans and animals.