Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Commentary : Patient’s Voice
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letter to the Editor – Authors’ reply
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Allied Health Professionals’ Corner
Author Reply
Book Review
Brief Communication
Case Report
Case Series
Clinical Case Report
Clinicopathological Conference
Commentary
Commentary : Patient’s Voice
Corrigendum
Editorial
Editorial – World Kidney Day 2016
Editorial Commentary
Erratum
Foreward
Guideline
Guidelines
Image in Nephrology
Images in Nephrology
In-depth Review
Letter to Editor
Letter to the Editor
Letter to the Editor – Authors’ reply
Letters to Editor
Literature Review
Nephrology in India
Notice of Retraction
Obituary
Original Article
Perspective
Research Letter
Retraction Notice
Review
Review Article
Short Review
Special Article
Special Feature
Special Feature - World Kidney Day
Systematic Review
Technical Note
Varia
View/Download PDF

Translate this page into:

Case Report
20 (
4
); 203-204
doi:
10.4103/0971-4065.73460

Chryseobacterium meningosepticum bacteremia in diabetic nephropathy patient on hemodialysis

Department of Microbiology and Nephrology, Father Muller Medical College, Mangalore, India

Address for correspondence: Dr. Meena Dias, Associate professor, Department of Microbiology, Fr. Muller Medical College, Mangalore, India. E-mail: drmeenadias@gmail.com

Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Disclaimer:
This article was originally published by Medknow Publications and was migrated to Scientific Scholar after the change of Publisher.

Abstract

The Chryseobacterium species are inhabitants of soil and water. In the hospital environment, they exist in water systems and wet surfaces. We report here a case of Chryseobacterium meningosepticum bacteremia in a diabetic nephropathy patient on hemodialysis. He was successfully treated with Vancomycin and ceftazidime for three weeks with good clinical outcome. This is the first case reported in dialysis patients from India.

Keywords

Chryseobacterium meningosepticum
bacteremia
hemodialysis

Introduction

Chryseobacterium meningosepticum, formerly known as Flavobacterium meningosepticum, has been reported to cause outbreaks of meningitis, primarily in premature newborns and infants in neonatal intensive care units (ICU).[12] In adults it can cause endocarditis, pneumonia and bacteremia, skin and soft infection.[135] There are a few reported cases of Chryseobacterium meningosepticum causing infection in dialysis patients.[69] We report here a 37-year-old with diabetic nephropathy on hemodialysis who developed bacteremia with this bacterium. Literature search showed this is the first reported case in dialysis patient from India.

Case Report

A 37-year-old man with stage V diabetic nephropathy was admitted in the nephrology unit of a tertiary care hospital with complaints of decreased urine output, low grade fever and puffiness of face and pedal edema for one week. He is a known diabetic and hypertensive on regular treatment. He is an A.C technician by occupation, working in the Middle East. He had undergone dialysis five times in the Middle East for the same complaints. At the time of admission, he had a temperature of 100.8°F, BP – 130/90 mm Hg, Pulse -80 beats/min, Respiratory rate – 20 breaths / min. On physical examination, he had pitting pedal edema. Hemogram showed hemoglobin 8.9gm%, total count 8300/cu mm with 71 % neutrophils, 22% lymphocytes, 6% eosinophils. Other investigations showed blood urea 125 mg/dl, s. creatinine 9.4 mg/dl, S. uric acid 5.3 mg/dl, total proteins 5.0 g/dl, Albumin 2.3 g/dl, A/G ratio 0.9, Random blood sugar 110 mg/dl. HIV, HBsAg and HCV ELISA were negative.

Microbiological Workup

The blood culture collected after dialysis grew Gram negative bacilli after 48 hours of incubation at 37°C. On blood agar, the colonies were small, convex, non hemolytic, pale yellow pigmented colonies. The Gram negative rod was non motile, catalase and oxidase positive, non nitrate reducing, OF glucose utilized oxidatively, Bile Esculin and indole positive, DNA’se negative, Arginine was dehydrolized. It did not grow at 42°C and was resistant to Polymyxin B. Based on these biochemical reactions it was identified as Chryseobacterium meningosepticum. Antibiotic susceptibility was done on Muller Hinton agar by Kirby-Bauer disc diffusion method. The strain was sensitive to ceftazidime, ceftriaxone, cotrimoxazole, ciprofloxacin, piperacillin–tazobactum, cefoperazone–sulbactum and vancomycin. It was resistant to ampicillin, amoxyclav, aminoglycosides, imipenem, meropenem. A repeat blood culture taken after seven days also grew Chryseobacterium meningosepticum. The patient was treated with vancomycin 1 gm I.V stat single dose followed by vancomycin 500 mg once every five days for four weeks and ceftazidime 1 gm I.V post dialysis, on alternate days, for three weeks according to sensitivity results. The patient became afebrile and his subsequent blood cultures were sterile. Environmental screening was done to trace the source by culturing reverse osmosis water; dialysate fluid and tap water were sterile.

Discussion

Chryseobacterium spp are organisms of low virulence and their presence in clinical specimens usually represents colonization and not infection[1] except Chryseobacterium meningosepticum, which is clinically significant and known to cause variety of infections. C. meningosepticum infection in patients on dialysis is rare. There are a few published reports,[689] mainly reported from Asian countries. From India, most of the reported cases include meningitis[35] and endocarditis.[4] No reports of C. meningosepticum bacteremia in dialysis patients from India have been reported in English literature. There is only one report of Chryseobacterium septicemia in a renal allograft recipient.[10] Predisposing factors for Chryseobacterium meningosepticum infection include malignancy, neutropenia, diabetes, steroid use, malnutrition or being on dialysis. Colonization of patients through contaminated medical devices, humidifiers, incubators, intravenous catheters has been documented. They are inhabitants of soil and water and have been recovered from municipal water supplies and from hospital environment,[1] which can act as a potential source of infection resulting in outbreaks. Whenever there is an isolation of Chrysobacterium, an attempt should be made to trace the source of infection and stringent steps should be implemented to prevent the transmission of infection. Our patient had diabetic nephropathy stage V and was on regular maintenance dialysis. Our attempt to trace the source of infection was not successful as the environmental screening carried out to detect the possible source yielded negative results. The patient must have contracted the infection in Middle East where he had undergone dialysis previously.

Chryseobacterium meningosepticum has a peculiar antibiotic profile. The bacteria is inherently resistant to most antibiotics prescribed to treat gram negative bacteria like aminoglycosides, β-lactam agents, Chloramphenicol, carbapenems (due to the production of two betalactamases, ESBL and Class B Carbapenem, Hydrolyzing metallolacomtamase), but susceptible to agents used to treat gram positive bacteria (Rifampicin, Ciprofloxacin, Vancomycin, trimethoprim–sulfamethoxazole). Hence the appropriate choice of antibiotic for the treatment is difficult. Results of the susceptibility testing vary when different methods are used; further complicating the choice of antibiotic. The disc diffusion methods are unreliable and broth microdilution is the preferred method.[1] Though Vancomycin was used earlier to treat the patients, there are reports showing failure of this drug. Drugs like Minocyclin, trimethoprim-sulphamethoxazole and Rifampicin may be the good alternatives.[137] More studies are required for the evaluation of these drugs against C. meningosepticum. However, our patient responded well to Vancomycin and ceftazide.

In conclusion, Chryseobacterium meningosepticum can be a potential nosocomial pathogen. Positive identification of the organism enables prompt treatment and increases the chances of recovery. Administration of appropriate antibiotics, strict adherence to hand washing, routine screening of hospital water samples especially in dialysis units can prevent outbreaks with this bacteria.

Source of Support: Nil

Conflict of Interest: None declared.

References

  1. , , . Other Gram negative and Gram variable Bacilli. In: In Mandell, Douglas and Bennett’s principles and practice of infectious diseases (6th edi). Philadelphia: Elsevier Churchill Livingstone; . p. :2751-768.
    [Google Scholar]
  2. , , . Meningitis in a new born due to Flavobacterium meningosepticum. Indian J Med Res. 1971;59:1006-8.
    [Google Scholar]
  3. , , , . Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine. 1997;76:30-41.
    [Google Scholar]
  4. , , , . Endocarditis due to Chryseobacterium meningosepticum. Indian J Med Microbiol. 2007;25:161-2.
    [Google Scholar]
  5. , , , , , , . Chryseobacterium meningosepticum--an uncommon pathogen causing adult bacterial meningitis. Indian J Pathol Microbiol. 2006;49:294-5.
    [Google Scholar]
  6. , , , , . Catheter related Chryseobacterium meningosepticum bacteraemia in a haemodialysis patient. NDT Plus. 2009;2:433-4.
    [Google Scholar]
  7. , , , , , , . Clinical and microbiological analysis of bloodstream infections caused by Chryseobacterium meningosepticum in nonneonatal patients. J Clin Microbiol. 2004;42:3353-5.
    [Google Scholar]
  8. , , . Chryseobacterium meningosepticum infections in a dialysis unit. Ceylon Med J. 2004;49:57-60.
    [Google Scholar]
  9. , , , . Chryseobacterium meningosepticum sepsis complicated with retroperitoneal hematoma and pleural effusion in a diabetic patient. J Chin Med Assoc. 2008;71:473-6.
    [Google Scholar]
  10. , , , , , . Chryseobacterium septicaemia in a renal allograft recipient. Clin Exp Nephrol 2009
    [Google Scholar]
Show Sections