|Year : 2018 | Volume
| Issue : 1 | Page : 70-72
Chryseobacterium indologenes: Case report of an emerging pathogen
Gurpreet Singh Bhalla1, Shilpi Gupta1, Manbeer Singh Sarao2, Dinesh Kalra3
1 Department of Laboratory Sciences, Army Hospital (R&R), New Delhi, India
2 Detroit Medical Centre, Michigan, USA
3 Department of Microbiology, Command Hospital (WC), Chandimandir Cantonment, Haryana, India
|Date of Web Publication||9-Jul-2018|
Maj Gurpreet Singh Bhalla
Department of Laboratory Sciences, Army Hospital (R&R), New Delhi - 110 010
Source of Support: None, Conflict of Interest: None
Chryseobacterium indologenes thrives well in the environment and does not contribute to the human flora. It is recently being reported to cause a plethora of diseases in humans and has been shown to destroy antimicrobial agents and tissues. We report a case of catheter-associated urinary tract infection (CAUTI) in an immunocompromised male who was treated successfully with appropriate oral antibiotics. Also presented is a review, though not an exhaustive one, of the various case reports from India, proving the organism to be an important, emerging, and potentially dangerous nosocomial pathogen.
Keywords: Catheter-associated urinary tract infection, Chryseobacterium indologenes, immunocompromised
|How to cite this article:|
Bhalla GS, Gupta S, Sarao MS, Kalra D. Chryseobacterium indologenes: Case report of an emerging pathogen. J Mar Med Soc 2018;20:70-2
| Introduction|| |
Catheter-associated urinary tract infections (CAUTIs) are associated with substantially increased morbidity and mortality and escalated cost of health care, and are generally caused due to the disruption of sterile procedures during any stage from insertion to care of the catheter. A major chunk of nosocomial infections include CAUTI from which the most commonly isolated pathogens are multidrug-resistant Enterobacteriacea (Escherichia coli, Klebsiella, Proteus, Enterobacter, and Citrobacter spp.), Pseudomonas aeruginosa, Candida, and Enterococcus spp. Occasionally rare, environmental pathogens are isolated which are labeled as collection contaminants and disregarded. Such organisms could be considered pathogenic depending on the clinical condition of the patient.
We report a case of CAUTI caused by such an organism, Chryseobacterium indologenes, in an immunocompromised patient.
| Case Report|| |
A 36-year-old male patient presented with complaints of fever and pain on micturition of 5-day duration. He gave a history of urinary catheterization at a local clinic following an episode of pain abdomen, where he was admitted for a day and discharged with anti-spasmodic drugs (no documents were available). He is a known case of human immunodeficiency virus (HIV) infection, detected 10 years ago, and was put on antiretroviral therapy (details not available). For the last 4 years, he stopped taking his medicines due to financial problems. He also gave a history of loss of 20 kg body weight in 3 months with weight at the time of reporting being 55 kg.
Examination revealed axillary and inguinal lymphadenopathy with lymph node size reaching up to 1.5 cm. was found to have oral candidiasis. Other systemic examination was unremarkable.
Investigations revealed a hemoglobin of 10.2 g/dL and total leukocyte count of 4300/μL (with 51% neutrophils) with other biochemical parameters being normal. He was detected to be seropositive for HIV and negative for HBsAg and anti-HCV antibodies. He was also found to have esophageal candidiasis on endoscopic examination. His CD4+ cell count was 66/μL. (He remembered the counts to be >350/μL when last done in 2013.)
Midstream urine sample was received in the laboratory for culture and antibiotic susceptibility testing. Uncentrifuged sample was suggestive of pyuria and tested positive (++) for protein and negative for glucose on dipstick examination. Culture showed significant bacteriuria and pure, nonlactose fermenting colonies of 2–3 mm diameter, translucent, convex, with entire margins within 24 h at 37°C on cystine, lactose, electrolyte-deficient media. The isolate was confirmed to be C. indologenes by standard biochemical tests (discussed later) and by VITEK 2 (bioMérieux, France).
Isolate was found to be susceptible to trimethoprim-sulfamethoxazole and minocycline. Blood cultures were negative for growth.
The patient was managed for urinary symptoms with oral trimethoprim-sulfamethoxazole (800 + 160 mg) 12 hourly for 7 days and improved significantly, two repeat cultures being negative for growth.
The patient was referred to the concerned specialist for restarting antiretroviral therapy, but was lost to follow-up.
| Discussion|| |
C. indologenes is a rare human pathogen, found widely in nature. It is a Gram-negative, aerobic, nonmotile, catalase, oxidase and indole positive bacilli, utilizes glucose oxidatively and does not grow on MacConkey agar. The organism produces a nondiffusible yellow pigment (flexirubin) and, hence, was earlier called Flavobacterium indologenes. Due to the reaction between flexirubin pigment and KOH, the colonies turn pink-red on addition of 20% KOH [Figure 1].
|Figure 1: Pigmented yellow colonies of Chryseobacterium indologenes (a); which turn pink-red (arrow) on addition of 20% KOH (b)|
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The organism survives in chlorinated water supplies and can form biofilms, thereby easily colonizing hospital environment or patients through contaminated medical equipment. It has been reported to cause urinary tract infections, pneumonia, bacteremia/sepsis, peritonitis, and ocular infections. The organism shows resistance to multiple antibiotics including carbapenems due to production of Class A β-lactamases and Class B carbapenem-hydrolyzing β-lactamases; hence, the treatment aspect becomes challenging. Protease activity of the organism is also thought to be a contributory virulence factor.,
A 5-year SENTRY program has reported C. indologenes to be an important clinical isolate as a nosocomial pathogen. Common risk factors for infection are use of invasive medical devices, comorbid illnesses (such as malignancy, chronic kidney disease, hypertension, and diabetes), immunocompromise, and the use of broad-spectrum antibiotics. Increased incidence after the use of tigecycline and colistin has been documented. Infections caused by the organism are associated with increase in mortality.,,,,
In the present case, the patient was immunocompromised and had a history of use of medical device as the risk factors; therefore, in such cases C. indologenes should be considered as pathogenic. The fact is supported by the increase in number of reported cases.
A myriad of infections caused by C. indologenes, have been reported worldwide; however, there is a dearth of data on the exact prevalence. The authors, to the best of their knowledge, have tried to summarize the cases reported from India, in [Table 1]. It is evident from the data that most infections follow an invasive procedure performed at a healthcare setup and most of the patients had some form of immune depression. It is noteworthy that though the organism has generally been reported in texts as multidrug resistant, outcomes have been favorable with appropriate therapy even in immunocompromised patients.
|Table 1: Summary of demographic and clinical profile of Chryseobacterium indologenes infections reported from India|
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Since C. indologenes does not form a part of human flora, it is recommended that the isolate should be viewed as a potential pathogen and its isolation from a clinical specimen should be taken as an indicator of breech in infection control procedures and practices.
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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