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Year : 2003  |  Volume : 21  |  Issue : 3  |  Page : 217-218
 

Multidrug resistant chromobacterium violaceum: An unusual bacterium causing long standing wound abscess


National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata - 700 010, India

Correspondence Address:
National Institute of Cholera and Enteric Diseases, Beliaghata, Kolkata - 700 010, India



How to cite this article:
Dutta S, Dutta S K. Multidrug resistant chromobacterium violaceum: An unusual bacterium causing long standing wound abscess. Indian J Med Microbiol 2003;21:217-8


How to cite this URL:
Dutta S, Dutta S K. Multidrug resistant chromobacterium violaceum: An unusual bacterium causing long standing wound abscess. Indian J Med Microbiol [serial online] 2003 [cited 2018 Nov 17];21:217-8. Available from: http://www.ijmm.org/text.asp?2003/21/3/217/8025


Dear Editor,
Of the two species of Chromobacterium, only  Chromobacterium violaceum   been rarely implicated in human disease. A wide variety of aerobic and anaerobic species of bacteria may be responsible either singly or in combination for wound or any soft tissue infection, the commonest bacteria being S. aureus, S. pyogenes,  Escherichia More Details coli, Proteus species, Clostridium perfringens, Bacteroides species etc. Here we report one case with non -healing wound infection and ulcer caused by C. violaceum.
A male patient of 24 years old presented with a wound abscess on his right leg (approx. 2.5cm in diameter) for a period of 2 weeks, which was not responding to usual antibiotic treatment. He was treated with oral amoxicillin (500mg thrice daily) for one week and then changed to cephalexin (500mg thrice daily) for 6 days with no result. The wound continued to persist with discharging pus. Pus was aspirated aseptically from the wound with a needle along with necrotic tissue and sent to microbiology laboratory for bacteriological culture and antimicrobial susceptibility result.
The sample was inoculated on to nutrient agar, blood agar and MacConkey agar media and incubated overnight at 37C aerobically and anaerobically. After 24 hours of incubation pure growth of plenty of violet coloured colonies appeared on all agar media. On further testing it was found to be gram negative bacillus, nonlactose fermenter, motile, catalase and oxidase positive, fermented glucose with production of only acid and no gas. The striking feature observed was it produced profuse violet pigment on ordinary media, which did not diffuse through medium. It was identified as C. violaceum by several biochemical tests, which included utilization of citrate, reduction of nitrate, fermentation of manniol and decarboxylation of arginine and ornithine. Indole production and lysine decarboxylation were negative.[1] Probable identification of C.violaceum was further confirmed by the 20E API system (BioMerieux, France).
The organism was found sensitive to chloramphenicol, tetracycline, cotrimoxazole, ciprofloxacin and other fluoroquinolone derivatives (except norfloxacin to which the organism was intermediately sensitive), gentamicin, amikacin and netlimicin, but resistant to penicillin, ampicillin, amoxicillin, cloxacillin, carbenicillin, erythromycin, roxithromycin, azithromycin, cephalexin, cefuroxime, ceftazidime, cefazolin and cefadroxil. It was intermediately sensitive to cefotaxime, norfloxacin and polymyxcin B. Antimicrobial susceptibility pattern was tested by the Stoke's comparative disc diffusion antibiotic sensitivity testing method.[2] According to the susceptibility result the patient was treated with oral administration of ciprofloxacin in a dose of 20 mg/kg/day in two divided doses for 10 days. The wound healed completely without any residual abscess.
The aforementioned procedures were repeated with another pus sample collected from the same patient on the second consecutive day, which gave exactly the same result. The sample was repeated to rule out the possibility of contamination. Isolation of the same organism in pure culture indicated its role in causing the disease.
C. violaceum is found in the soil and water of tropical and subtropical areas like India, Malaysia, Trinidad. It is a bacterium of low virulence causing occasional localized infection. In immunocompromised individual the localized lesion might lead to septicaemic infections with abscesses in multiple internal organs, urinary tract infection and diarrhoea. Mortality rate is very high for patients with disseminated infections.
The present study reports wound infection by C. violaceum, which probably originated from soil contamination of the wound. The patient was otherwise healthy and had no history of diabetes mellitus or other compromising illnesses. Fortunately the infection was confined to the local wound without dissemination. Other initial laboratory findings were blood leucocyte total count, 18,600 cells/L (80% neutrophils, 18% lymphocytes, 1% eosinophil, and 1% basophil); erythrocyte sedimentation rate (Westerngreen method) was 18 mm/hour; and fasting blood sugar level, was 94 mgm%. Although initially the response with commonly used antibiotics was very poor, yet the patient responded well and was cured completely when appropriate antimicrobial was started. Although rare, C. violaceum has been reported in other studies, to cause localized lesion leading to systemic infections including septicaemia, brain abscess, multiple organ abscess and diarrhoea if left untreated.[3],[4],[5]
Keeping this in view it may be said that in patients with longstanding wound lesion not responding to empirical antimicrobial treatment, the possibility of C. violaceum infection should be ruled out to prevent further disseminated and fatal systemic infection. Culture and susceptibility result of pus samples is also necessary before switching over to next effective drug for treatment. 

 ~ References Top

1.Mitchell RG. In: Parker MT, Duerden BI. (Eds) Miscellaneous bacteria. Topley and Wilson's Principles of Bacteriology, Virology and Immunity, Vol. 2.8th ed. (Edward Arnold, London). 1990:589-591.  Back to cited text no. 1    
2.Stokes EJ, Ridgway GL, Wren MWD. Clinical Microbiology. 7th ed.( Edward Arnold, London). 1993:239-250.  Back to cited text no. 2    
3.Atapattu DN, Jayawickrama DP, Thevanesam V. An unusual bacterium causing brain abscess. Emer Infec Dis 2001;7(1):159-160.  Back to cited text no. 3    
4.Shao PL, Hsueh PR, Chang YC, et al. Chromobacterium violaceum infection in children: a case of fatal septicaemia with nasopharyngeal abscess and literature review. Paediatr Infect Dis J 2002;21(7):707-709.  Back to cited text no. 4    
5.Ballal M, Kini P, Rajeswari D, et al. Chromobacterium violaceum diarrhoea. Indian J Paediatric 2000;67(5):388-389.   Back to cited text no. 5    
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2004 - Indian Journal of Medical Microbiology
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