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  Table of Contents  
CORRESPONDENCE
Year : 2016  |  Volume : 34  |  Issue : 3  |  Page : 394-395
 

Spontaneous septic arthritis due to Burkholderia cepacia in a 3-month-old pre-term infant


1 Department of Microbiology, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India
2 Department of Neonatology, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu, India

Date of Submission29-Jun-2015
Date of Acceptance09-Jan-2016
Date of Web Publication12-Aug-2016

Correspondence Address:
S Nivedhana
Department of Microbiology, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti CHILDS Trust Hospital, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.188374

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How to cite this article:
Nivedhana S, Sulochana P, Shobana R. Spontaneous septic arthritis due to Burkholderia cepacia in a 3-month-old pre-term infant. Indian J Med Microbiol 2016;34:394-5

How to cite this URL:
Nivedhana S, Sulochana P, Shobana R. Spontaneous septic arthritis due to Burkholderia cepacia in a 3-month-old pre-term infant. Indian J Med Microbiol [serial online] 2016 [cited 2019 Sep 22];34:394-5. Available from: http://www.ijmm.org/text.asp?2016/34/3/394/188374


Dear Editor,

Burkholderia cepacia complex (BCC) causes infections that are proving difficult to treat because of both high intrinsic (aminoglycosides and colistin) and acquired resistance (β lactams) and also occasionally to co-trimoxazole (the drug of choice). [1],[2],[3] We are describing a rare case of spontaneous septic arthritis by BCC in a pre-term infant.

A 3-month-old pre-term intrauterine growth retarded (IUGR), female infant (2.02 kg) was admitted to the neonatology intensive care unit for the paucity of movements in both legs for 3 days and failure to thrive. This was not associated with fever or trauma. There was no history of decreased intake of feeds/lethargy/irritability. On examination, she was alert with restricted movements of both limbs. The heart rate was 110/min and respiratory rate was 36/min, SPO 2 97% at room temperature.

Investigations revealed elevated C-reactive protein (CRP) - 27.9 mg/L, white blood cell count - 14,500 cells/mm 3 (lymphocytes - 70%), red blood cell count - 4.8 millions/mm 3 and hemoglobin - 11.5 g%. Ultrasonography (USG) hip showed a bilateral collection of minimal intracapsular fluid with internal echos. USG of abdomen and brain were normal. Blood and cerebrospinal fluid cultures showed no growth.

Aspirate loaded onto BacT/ALERT PF Plus bottle yielded growth of B. cepacia [Figure 1], which was sensitive to ceftazidime (MIC 2), levofloxacin (MIC 1), minocycline (MIC ≤1), meropenem (MIC 1) and cotrimoxazole (MIC ≤20) (VITEK-2). The infant was placed on contact isolation and treated with intravenous (IV) meropenem (80 mg) thrice daily and syrup co-trimoxazole (0.8 ml) thrice daily for 4 weeks.
Figure 1: Growth of Burkholderia cepacia on blood and MacConkey agar

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Subsequent aspirate showed no growth, CRP was negative (1.4). At discharge, both hip joint movements had improved with good cry and tone and the infant was taking adlib bottle feeds. Syrup co-trimoxazole was continued and tablet levofloxacin 500 mg ¼ was added for two more weeks.

This infant was symptomatic on admission, and the arthritis was most likely due to hematological seeding of the joint. The blood culture showed no growth which could have resulted from a smaller amount of inoculated blood. [4] The infant was delivered by caesarean owing to fetal distress at 32 weeks of gestation (weight - 1.4 kg). She had been on an incubator for 20 days requiring oxygen, IV lines and had received nasogastric feeds initially for 5 days. There were no prior injections or surgeries on the infected hip joints. Concrete source identification was not possible in our case, but we speculate that the infection was contracted during previous hospitalisation superimposed on the setting of pre-maturity and IUGR.

We conclude that the drugs for treating BCC infections are already limited and could prove fatal if misidentified or reported as Pseudomonas species since its susceptibility is in complete contrast to that of Pseudomonas. [5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 ~ References Top

1.
Gautam V, Singhal L, Ray P. Burkholderia cepacia complex: Beyond Pseudomonas and Acinetobacter. Indian J Med Microbiol 2011;29:4-12.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Gautam V, Ray P, Vandamme P, Chatterjee SS, Das A, Sharma K, et al. Identification of lysine positive non-fermenting gram negative bacilli (Stenotrophomonas maltophilia and Burkholderia cepacia complex). Indian J Med Microbiol 2009;27:128-33.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Avgeri SG, Matthaiou DK, Dimopoulos G, Grammatikos AP, Falagas ME. Therapeutic options for Burkholderia cepacia infections beyond co-trimoxazole: A systematic review of the clinical evidence. Int J Antimicrob Agents 2009;33:394-404.  Back to cited text no. 3
    
4.
Miki RA, Rubin LE, Kirk J, Dodds SD. Spontaneous septic arthritis caused by Burkholderia cepacia. Iowa Orthop J 2006;26:147-50.  Back to cited text no. 4
    
5.
Gautam V, Singh M, Singhal L, Kaur M, Kumar A, Ray P. Burkholderia cepacia complex in Indian cystic fibrosis patients. Indian J Med Res 2012;136:882-3.  Back to cited text no. 5
[PUBMED]  Medknow Journal  


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