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Bacteremia by Chryseobacterium oranimense, A Colistin-Resistant Gram-Negative Bacilli, in an Immunocompetent Pediatric Patient

Villaverde González, Serena, MD; Eugenieva Marinova, Feia, MD; Rasines Rodríguez, Alejandro, MD; Orden Martínez, Beatriz, MD, PhD; Golmayo Gaztelu, Luz, MD; Saez Nieto, Juan Antonio, MD, PhD; Cilleruelo Ortega, M. José, MD, PhD

The Pediatric Infectious Disease Journal: February 2019 - Volume 38 - Issue 2 - p 217–218
doi: 10.1097/INF.0000000000002236
Letters to the Editor
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Pediatric Infectious Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Department of Microbiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Pediatric Infectious Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Department of Microbiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Pediatric Infectious Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Area of Bacteriology, mycology and parasitology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain

Pediatric Infectious Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

The authors have no funding or conflicts of interest to disclose.

Address for correspondence: M. José Cilleruelo Ortega, MD, PhD, Pediatric Infectious Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, Calle Manuel de Falla, 1, 28222 Majadahonda, Madrid, Spain. E-mail: mjose.cilleruelo@gmail.com.

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To the Editors:

We report the case of a 6-year-old girl, with autism spectrum disorder, who attended the emergency department because of an episode of decreased level of consciousness without paroxysmal movements, lasting 3 minutes, with fever the last few hours. She showed somnolence, lethargy and incomprehensible sounds, without neck stiffness, meningeal or focal signs. A blood sample was taken with normal results except C-reactive protein 74 mg/L, and lumbar puncture was performed (cerebrospinal fluid : glucose 53 mg/dL; proteins 25,5 mg/dL, 1 leucocyte/mm3). The patient was admitted and treated with intravenous acyclovir and cefotaxime. On the third day, the blood culture showed the isolation of Chryseobacterium oranimense. No other samples were taken for further cultures. Polymerase chain reaction in cerebrospinal fluid for herpes simplex, varicella zoster and enterovirus yielded negative results.

The blood culture was incubated in a Bactec-FX instrument (Becton Dickinson). Bacterial growth was detected within 17.07 hours of incubation. The isolate was identified using MALDI-TOF (Brucker, Germany) mass spectrometer, where no other bacteria were isolated. Results were confirmed in the Centro Nacional de Microbiología by means of 16s recombinant DNA sequence analysis using a previously reported method.1 Antibiotic susceptibility testing was performed by automated broth microdilution (MicroScan; Becman-Coulter), and minimal inhibitory concentration results were interpreted by using European Committee on Antimicrobial Susceptibility Testing (EUCAST) interpretive criteria for Pseudomonas species. The isolate was susceptible to the following antibiotics: ciprofloxacin, trimethoprim-sulfamethoxazole, minocycline and piperacillin-tazobactam and resistant to colistin, second- and third-generation cephalosporins and carbapenems.

With the diagnosis of bacteremia by C. oranimense, antibiotic treatment was changed to ciprofloxacin. Fever disappeared in 24 hours, as expected from the antibiotic susceptibility test, and the patient was discharged 7 days after admittance. She received 7 days of acyclovir and 2 weeks of antibiotics: initially ciprofloxacin followed by oral trimethoprim-sulfamethoxazole. Four weeks after discharge, the patient remained asymptomatic. Immunoglobulins and lymphocyte subsets were analyzed, with normal results.

C. oranimense is a Gram-negative, aerobic, nonmotile rod, catalase and oxidase-positive.2 It was isolated from raw cow’s milk in Israel in April 20043. The genus Chryseobacterium contains around 80 species, widely distributed in aquatic and soil environments, and some species are pathogenic to humans and animals.2 Members of the genus Chryseobacterium have been documented as opportunistic pathogens associated with nosocomial infections in infants and immunocompromised patients of all age groups.4 The most common species causing human disease are C. meningosepticum and C. indologenes.

To the authors’ knowledge, this is the first case of invasive disease caused by C. oranimense in an immunocompetent patient. There is a single published case of isolation of this bacterium, in the sputum of a 26-month-old child, previously diagnosed of cystic fibrosis. The patient was coinfected with Stenotrophomonas maltophilia and Pseudomona aeruginosa and had received a prolonged treatment with colistin prior the isolation of C. oranimense. The authors consider that colistin therapy could lead to the selection of the colistin-resistant bacterium and conclude that C. oranimense could be considered an opportunistic human pathogen in immunocompromised patients.5

Even more, the only published data on isolation of Chryseobacterium species in human infections are recorded in immunosuppressed patients or during a prolonged broad spectrum antibiotic therapy.4 None of these risk factors were present in this case. Nevertheless, the patient’s parents report usual ingestions of inorganic substances (soil or grass) because of her behavioral alterations, which may be interesting to study as a possible route of acquisition.

Serena Villaverde González, MD

Pediatric Infectious Diseases Unit

Hospital Universitario Puerta de Hierro Majadahonda

Madrid, Spain

Feia Eugenieva Marinova, MD

Department of Microbiology

Hospital Universitario Puerta de Hierro Majadahonda

Madrid, Spain

Alejandro Rasines Rodríguez, MD

Pediatric Infectious Diseases Unit

Hospital Universitario Puerta de Hierro Majadahonda

Madrid, Spain

Beatriz Orden Martínez, MD, PhD

Department of Microbiology

Hospital Universitario Puerta de Hierro Majadahonda

Madrid, Spain

Luz Golmayo Gaztelu, MD

Pediatric Infectious Diseases Unit

Hospital Universitario Puerta de Hierro Majadahonda

Madrid, Spain

Juan Antonio Saez Nieto, MD, PhD

Area of Bacteriology, mycology and parasitology

Centro Nacional de Microbiología

Instituto de Salud Carlos III

Madrid, Spain

M. José Cilleruelo Ortega, MD, PhD

Pediatric Infectious Diseases Unit

Hospital Universitario Puerta de Hierro Majadahonda

Madrid, Spain

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REFERENCES

1. Drancourt M, Bollet C, Carlioz A, et al. 16S ribosomal DNA sequence analysis of a large collection of environmental and clinical unidentifiable bacterial isolates. J Clin Microbiol. 2000;38:3623–3630.
2. Venil CK, Nordin N, Zakaria ZA, et al. Chryseobacterium artocarpi sp. nov., isolated from the rhizosphere soil of Artocarpus integer. Int J Syst Evol Microbiol. 2014;64(Pt 9):3153–3159.
3. Hantsis-Zacharov E, Shakéd T, Senderovich Y, et al. Chryseobacterium oranimense sp. nov., a psychrotolerant, proteolytic and lipolytic bacterium isolated from raw cow’s milk. Int J Syst Evol Microbiol. 2008;58(Pt 11):2635–2639.
4. Chen FL, Wang GC, Teng SO, et al. Clinical and epidemiological features of Chryseobacterium indologenes infections: analysis of 215 cases. J Microbiol Immunol Infect. 2013;46:425–432.
5. Sharma P, Gupta SK, Diene SM, et al. Whole-genome sequence of Chryseobacterium oranimense, a colistin-resistant bacterium isolated from a cystic fibrosis patient in France. Antimicrob Agents Chemother. 2015;59:1696–1706.
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