|Year : 2020 | Volume
| Issue : 2 | Page : 226-228
Catheter-related Brevibacterium casei bloodstream infection in a child with aplastic anaemia
Sangeeta Joshi1, Ruchira Misra2, Suverna Kirolikar3, Sujata Mushrif4
1 Department of Microbiology, Manipal Hospital, Delhi, India
2 Department of Hematology and Bone Marrow Transplantation, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
3 Department of Microbiology, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
4 Department of Hemato-Oncology, SRCC Children's Hospital, Narayana Health, Mumbai, Maharashtra, India
|Date of Submission||28-Jun-2020|
|Date of Decision||05-Jul-2020|
|Date of Acceptance||15-Jul-2020|
|Date of Web Publication||29-Aug-2020|
Dr. Sangeeta Joshi
Manipal Hospital, Delhi
Source of Support: None, Conflict of Interest: None
Brevibacteria are a part of the normal skin flora and may be dismissed in blood cultures as contaminants. They have been reported as opportunistic pathogens in immunocompromised patients. We report a catheter-related bloodstream infection with Brevibacterium casei in a 6-year-old child with aplastic anaemia. Treatment with appropriate antibiotics along with the removal of the catheter resulted in complete cure in our patient.
Keywords: Aplastic anemia, Brevibacterium casei, sepsis
|How to cite this article:|
Joshi S, Misra R, Kirolikar S, Mushrif S. Catheter-related Brevibacterium casei bloodstream infection in a child with aplastic anaemia. Indian J Med Microbiol 2020;38:226-8
|How to cite this URL:|
Joshi S, Misra R, Kirolikar S, Mushrif S. Catheter-related Brevibacterium casei bloodstream infection in a child with aplastic anaemia. Indian J Med Microbiol [serial online] 2020 [cited 2020 Oct 24];38:226-8. Available from: https://www.ijmm.org/text.asp?2020/38/2/226/293909
| ~ Introduction|| |
Brevibacteria are non-fermenting, non-spore forming, non-motile Gram-positive coryneform bacilli which are catalase positive and are seen as a part of the normal skin flora and in dairy products. The Brevibacterium genus has many different species, but only ten have been isolated from clinical samples. Brevibacterium casei has been reported more frequently than the other species, but very few reports are from India. Here, we report a case of bloodstream infection with B. casei, related to catheter in an immunocompromised child.
| ~ Case Report|| |
The patient was a 6-year, 11-month-old male child, diagnosed with aplastic anaemia admitted for matched sibling donor peripheral blood stem cell (PBSC) transplant. Hickman line insertion was done 7 days pre-transplant. About 321 ml volume bone marrow was infused with supportive care. He developed fever on day +6 of post-PBSC associated with hypotension. Blood cultures were done from both the red and the white lumen of the catheter; intravenous (IV) fluid bolus was given and the child was started on IV meropenem and amikacin.
The complete blood cell count at the time of fever included a white blood cell count of 100/mm 3 (neutrophil 73%), haemoglobin of 10 g/dL and platelet count of 19 × 103/mm 3. The other biochemical parameters were normal with no evidence of liver or renal dysfunction.
The blood cultures were done by the BACTEC FX 40 system (Becton Dickinson and Company, Franklin Lakes, NJ). Both the blood cultures showed Gram-positive bacilli in the Gram stain and grew non-haemolytic white colonies on 5% sheep blood agar. The isolate was identified by PHOENIX BD 100 (Becton Dickinson and Company, Sparks, MD) as Brevibacterium species, which was confirmed to be B. casei by matrix-assisted laser desorption/ionisation time of flight assay. Antibiotic susceptibility was interpreted according to the Clinical and Laboratory Standards Institute M45 A3 guidelines. The isolate was susceptible to gentamicin (minimum inhibitory concentration [MIC] 1 ug/ml), ciprofloxacin (MIC 1 ug/ml), erythromycin (MIC ≤0.25 ug/ml), linezolid (MIC ≤2 ug/ml), doxycycline (MIC ≤0.5 ug/ml), daptomycin (MIC 1 ug/ml), meropenem (MIC 0.25 ug/ml) and vancomycin (MIC ≤0.5 ug/ml).
The child was treated with IV meropenem and amikacin and became afebrile within 48 hours. However, blood cultures sent 8 days later continued to grow B. casei from the white lumen. The catheter was removed and he was discharged after treatment with IV meropenem and amikacin for a total of 10 days. He continued his immunosuppressive medications. His neutrophil engraftment occurred on day +12 and the platelet engraftment on day +17.
On follow-up at 5 months post-transplant, the child continues to do well, with a normalisation of his haematological parameters. His chimerism was 96% on day 100 post-transplant.
| ~ Discussion|| |
B. casei has been isolated from both immunocompetent and immunocompromised patients. Although infections in the immunocompromised patients are mostly from Gram-negative bacteria in India, B. casei may be a cause for sepsis also.
Castagnola et al. reported  B. casei as one of the unusual pathogens in children with cancer. The patient was non- neutropenic at the time of B casei septicaemia and the catheter was removed. A 25-year-old male  with a diagnosis of testicular choriocarcinoma was receiving chemotherapy and he developed pancytopenia and fever, and the blood culture revealed B. casei. The patient was treated with piperacillin and teicoplanin for the first 10 days, and in the subsequent 10 days, he was on piperacillin and tobramycin. He relapsed two weeks after therapy was stopped, but was asymptomatic after the second course of antibiotics.
B. casei has been reported from an AIDS patient  from Hickman catheter and blood culture. This was a 34-year-old male with AIDS, who had persisting fever and pancytopenia. The patient was given vancomycin for eight days and the catheter was removed. He had no relapses. Bal et al. reported a 6-year-old child with acute lymphoblastic leukaemia who had a Hickman catheter and developed B. casei bloodstream infection. He was treated with vancomycin for 10 days, but the catheter was not removed. He had no relapses after B. casei septicaemia on the follow-up for six months.
B. casei has also been reported among immunocompetent patients. Magi et al. reported a case of bloodstream infection with B. casei, probably related to a port-a-cath, in an immunocompetent woman, with a previous history of immunosuppression. The patient was treated with teicoplanin followed by linezolid and the port-a-cath was removed. There were no relapses. A case of brain abscess due to B. casei in an immunocompetent patient  was reported. The patient was treated with empirical therapy with cefotaxime followed by 6 weeks of oral amoxicillin, resulting in complete cure of the infection.
B. casei has also been implicated in endocarditis in a patient with chronic liver disease. The patient was treated with IV vancomycin, but developed a relapse and gradually progressed to liver and kidney failure and expired. Althaf et al. reported a case of relapsing peritonitis with B. casei in a 33-year-old female known to have systemic lupus erythematosus complicated with lupus nephritis leading to end-stage renal disease on automated peritoneal dialysis. She was treated with IV vancomycin, but definitive eradication of the organism was only possible after peritoneal dialysis catheter removal. Two cases of recurrent bacteraemia caused by B. casei that were associated with infected long-term intravascular access have been described. Recurrence of bacteraemia caused by the same strain was demonstrated up to 5 months following initial adequate therapy. Based on this experience, the authors suggested that implanted device removal should be the preferred treatment for associated B. casei infection.
Our patient too developed the infection when he was immunocompromised and neutropenic and did not clear the infection till the central venous line was removed. Thereafter, he has done well and not had any further complications.
| ~ Conclusion|| |
Infections with B. casei are more commonly reported in immunocompromised patients, though cases have been described in immunocompetent patients as well. The previously considered skin commensal may be a cause for catheter-related infection or even sepsis. Endocarditis has also been reported for the same. Treating physicians of immunocompromised patients need to be watchful and should consider treating B. casei and not dismissing it as commensals. Persistence of infection in spite of adequate antibiotic treatment is known. Treatment with antibiotics along with the removal of the catheter generally results in complete cure of the infection.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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