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 ~  Abstract
 ~ Introduction
 ~ Case Report
 ~ Discussion
 ~  References
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  Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 380-381
 

Noncatheter-related bacteraemia due to Chryseobacterium indologenes in an immunocompetent patient


Department of Microbiology, NEIGRIHMS, Shillong, Meghalaya, India

Date of Submission08-Jan-2016
Date of Acceptance30-Jun-2016
Date of Web Publication12-Aug-2016

Correspondence Address:
C Lyngdoh
Department of Microbiology, NEIGRIHMS, Shillong, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.188359

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 ~ Abstract 

Chryseobacterium indologenes belongs to a group of nonfermentative Gram-negative bacilli and is an uncommon human pathogen. It causes severe infections such as septicaemia and ventilator-associated pneumonia in immunocompromised patients or after prolonged hospitalisation. We report a case of a noncatheter-related bacteraemia in a 22-year-old immunocompetent female whose blood culture showed the growth of C. indologenes, identified by Vitek GNI system (bioMerieux, France). The patient responded to treatment with ciprofloxacin. The pathogenicity and virulence factors of C. indologenes remain unclear. This case indicates that C. indologenes might cause symptomatic disease in immunocompetent persons with otherwise no associated underlying risk factors.


Keywords: Chryseobacterium indologenes, ciprofloxacin, Vitek GNI system


How to cite this article:
Baruah M, Lyngdoh C, Lyngdoh W V, Talukdar R. Noncatheter-related bacteraemia due to Chryseobacterium indologenes in an immunocompetent patient. Indian J Med Microbiol 2016;34:380-1

How to cite this URL:
Baruah M, Lyngdoh C, Lyngdoh W V, Talukdar R. Noncatheter-related bacteraemia due to Chryseobacterium indologenes in an immunocompetent patient. Indian J Med Microbiol [serial online] 2016 [cited 2019 Nov 18];34:380-1. Available from: http://www.ijmm.org/text.asp?2016/34/3/380/188359



 ~ Introduction Top


Chryseobacterium spp., previously called Flavobacterium, are a group of aerobic, nonfermentative, nonmotile, catalase-positive, oxidase-positive and indole-positive Gram-negative bacilli. They are rare human pathogen, but widely distributed in soil, plants, food and potable water. Chryseobacterium indologenes can cause serious infections in immunosuppressed patients. Intravascular devices such as venous catheters, intravascular implants, urinary catheters, intubation and mechanical ventilation are the risk factors for C. indologenes infection. Most of the cases of C. indologenes were reported from long-term hospitalised patients on mechanical support associated with the underlying disease. This case indicates that C. indologenes might cause symptomatic disease in immunocompetent patients with otherwise no associated underlying risk factors.


 ~ Case Report Top


We present a case of a 22-year-old female admitted with fever with chills and rigors for the past 2 days who was provisionally diagnosed to be a case of upper respiratory tract infection. There was no cough, headache, rash or burning micturition. There was no history of hospitalisation, invasive procedures or any past illness. She was not immunocompromised or diabetic.

On examination, the patient was febrile, chest was bilaterally clear and no organomegaly or lymphadenopathy was detected. Her blood pressure was 130/90 mm Hg, pulse rate was 88/min, SPO 2 was 100% and temperature was 100°C. Examination of the cardiovascular system and the central nervous system was within normal limits. Bedside Paracheck test and the peripheral blood smear for malarial parasite were negative. Chest X-ray showed no abnormality. Empirically, injection ceftriaxone was started after sending blood samples. Urine culture was sterile, and sputum culture showed the growth of normal upper respiratory flora. There was no growth of any enteric pathogens in the stool culture.

The biochemical parameters (Random blood sugar - 103 mmol/L, total serum protein - 7.4 mg/dl, albumin - 5 mg/dl, globulin - 2.4 mg/dl and albumin: globulin - 2:1), liver function tests (serum bilirubin - 1.5 mg/dl, direct - 0.3 mg/dl, indirect - 1.2 mg/dl, serum glutamic oxaloacetic transaminase - 23 IU/L and serum glutamic pyruvate transaminase - 14 IU/L) and kidney function tests (serum urea - 36 mg/dl, serum creatinine - 1.2 mg/dl, K - 3.2 mmol/L, Na - 140 mmol/L, Ca - 1.15 mmol/L and Cl - 105 mmol/L) were within normal limits. Peripheral blood picture was normal (haemoglobin - 12.5 g/dl, red blood cell - 5.22 × 10 6 , white blood cell - 9900, platelets - 160 × 10 3 and erythrocyte sedimentation rate - 2 mm/h).

The blood culture which was sent on day one of admission showed turbidity after 48 h. The subculture showed the growth of yellow-pigmented, nonfermentative, nonmotile, catalase-positive, oxidase-positive and indole-positive Gram-negative Bacilli on nutrient agar [Figure 1]. Haemolytic colonies were seen on blood agar, and no growth was seen in MacConkey agar. The isolate was identified by the Vitek GNI system (bioMerieux, France) as C. indologenes.
Figure 1: Growth of Chryseobacterium indologenes in nutrient agar

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The susceptibility patterns, determined by the disc diffusion method, showed sensitivity to piperacillin, ofloxacin, ciprofloxacin and piperacillin-tazobactam; intermediate sensitivity to cefoperazone; and resistant to ampicillin, gentamicin, cefotaxime, ceftriaxone, imipenem and ceftazidime. Two more blood samples sent on the consecutive days showed the same isolate with the same sensitivity pattern.

On day four of admission, injection ciprofloxacin was started. She showed considerable improvement within 48 h and was discharged after 1 week. She came for follow-up after 3 days. Blood sample collected at this time was sterile.


 ~ Discussion Top


Most of the reported cases of C. indologenes infections occurred in immunocompromised patients or in patients with invasive devices during their hospital stay. [1],[2],[3] Christakis et al. reported a case of noncatheter-related bacteraemia by C. indolens in a person with a solid tumour. [4] Our patient did not have any of the above-mentioned risk factors, and the portal of entry of the organism could not be ascertained. In this case, the patient presented with the symptoms of septicaemia, and the blood culture grew C. indologenes. No other foci of infection were found, and her symptoms showed a remarkable improvement after therapy with ciprofloxacin. The repeat blood culture was sterile after 1 week of completion of the antibiotic therapy. Douvoyiannis et al. also reported C. indologenes bacteraemia in a previously healthy infant. [5]

C. indologenes is readily distinguished from other nonfermenters by its ability to produce indole. Despite its low virulence, it is inherently resistant to many antimicrobials. In a case reported by Cascio et al., C. indologenes bacteraemia in a diabetic child responded to treatment with a single agent after in vitro susceptibility tests were performed. [6] This signifies that nondevice-associated disease can be treated with a single antibiotic as seen in our case. There are very limited case reports on C. indologenes. The pathogenicity and virulence factors remain unclear. When significant infections are encountered, susceptibility testing is necessary because of the unpredictability of antimicrobial resistance of these organisms. Extensive surveillance programmes are necessary to understand the clinical importance when this rare pathogen is isolated.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 ~ References Top

1.
Nulens E, Bussels B, Bols A, Gordts B, Van Landuyt HW. Recurrent bacteremia by Chryseobacterium indologenes in an oncology patient with a totally implanted intravascular device. Clin Microbiol Infect 2001;7:391-3.  Back to cited text no. 1
    
2.
Ferreira Rde S, Brandão FF, Lobo SM. Chryseobacterium indologenes infection: A case report. Rev Bras Ter Intensiva 2010;22:96-8.  Back to cited text no. 2
    
3.
Calderón G, García E, Rojas P, García E, Rosso M, Losada A. Chryseobacterium indologenes infection in a newborn: A case report. J Med Case Rep 2011;5:10.  Back to cited text no. 3
    
4.
Christakis GB, Perlorentzou SP, Chalkiopoulou I, Athanasiou A, Legakis NJ. Chryseobacterium indologenes non-catheter-related bacteremia in a patient with a solid tumor. J Clin Microbiol 2005;43:2021-3.  Back to cited text no. 4
    
5.
Douvoyiannis M, Kalyoussef S, Philip G, Mayers MM. Chryseobacterium indologenes bacteremia in an infant. Int J Infect Dis 2010;14:e531-2.  Back to cited text no. 5
    
6.
Cascio A, Stassi G, Costa GB, Crisafulli G, Rulli I, Ruggeri C, et al. Chryseobacterium indologenes bacteraemia in a diabetic child. J Med Microbiol 2005;54(Pt 7):677-80.  Back to cited text no. 6
    


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