1
|
Hedary AS, DeBord NL, Marshall D. A Case Report of Necrotizing Pneumonia Due to Burkholderia cepacia Syndrome. Cureus 2024; 16:e52955. [PMID: 38406162 PMCID: PMC10894023 DOI: 10.7759/cureus.52955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Burkholderia cepacia (B. cepacia) complex is a highly resistant gram-negative pathogen known to cause lung infection in cystic fibrosis, chronic granulomatous disease, and immunocompromised patients. However, it may rarely infect immunocompetent patients as well. Here, we present the case of a 30-year-old male patient who was treated for B. cepacia pneumonia in the hospital, discharged with oral antibiotics, and returned two months later with recurring B. cepacia pneumonia and bacteremia. The patient rapidly declined over the next 24 hours and expired in the intensive care unit. This case is significant as it is one of very few published cases of cepacia syndrome in a patient with no evidence of immunodeficiency. In conclusion, cases of B. cepacia pneumonia must be monitored vigilantly for progression to cepacia syndrome, even in immunocompetent patients. Additional studies regarding optimized antibiotic regimens and effective treatment modalities for B. cepacia infection are warranted.
Collapse
Affiliation(s)
- Antoine S Hedary
- Family Medicine, Louisiana State University Health Sciences Center, Alexandria, USA
| | - Nikki L DeBord
- Family Medicine, Louisiana State University Health Sciences Center, Alexandria, USA
| | - Diahann Marshall
- Family Medicine, Louisiana State University Health Sciences Center, Alexandria, USA
| |
Collapse
|
2
|
Singhal T, Wani S, Shah S, Thakkar P, Vidisha Daiya, Veeraraghavan B. Burkholderia cepacia complex as a cause of community acquired bacteremia in a young immuncompetent male. Indian J Med Microbiol 2023; 46:100422. [PMID: 37945116 DOI: 10.1016/j.ijmmb.2023.100422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 11/12/2023]
Abstract
Burkholderia cepacia complex (BCC) is a well-recognized cause of nosocomial infections. We describe here a young healthy male who presented with fever and chest pain with ECG changes of acute pericarditis. Two sets of blood cultures at separate timings grew gram negative bacilli identified as BCC by molecular methods. The patient responded to intravenous ceftazidime despite high ceftazidime MIC's. The source of infection was probably contaminated nasal spray/nasal saline wash which he used after a balloon sinoplasty procedure one month ago. Issues related to accurate identification and susceptibility testing of BCC are also discussed.
Collapse
Affiliation(s)
- Tanu Singhal
- Department of Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Sunil Wani
- Department of Cardiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Sweta Shah
- Department of Microbiology and Infection Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Pooja Thakkar
- Department of Microbiology and Infection Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Vidisha Daiya
- Department of Infectious Disease. Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Balaji Veeraraghavan
- The Hilda Lazarus Core Research Chair, Christian Medical College & Hospital, Vellore, India.
| |
Collapse
|
3
|
Taher NM, Hvorecny KL, Burke CM, Gilman MS, Heussler GE, Adolf-Bryfogle J, Bahl CD, O'Toole GA, Madden DR. Biochemical and structural characterization of two cif-like epoxide hydrolases from Burkholderia cenocepacia. Curr Res Struct Biol 2021; 3:72-84. [PMID: 34235487 PMCID: PMC8244358 DOI: 10.1016/j.crstbi.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 11/04/2022] Open
Abstract
Epoxide hydrolases catalyze the conversion of epoxides to vicinal diols in a range of cellular processes such as signaling, detoxification, and virulence. These enzymes typically utilize a pair of tyrosine residues to orient the substrate epoxide ring in the active site and stabilize the hydrolysis intermediate. A new subclass of epoxide hydrolases that utilize a histidine in place of one of the tyrosines was established with the discovery of the CFTR Inhibitory Factor (Cif) from Pseudomonas aeruginosa. Although the presence of such Cif-like epoxide hydrolases was predicted in other opportunistic pathogens based on sequence analyses, only Cif and its homolog aCif from Acinetobacter nosocomialis have been characterized. Here we report the biochemical and structural characteristics of Cfl1 and Cfl2, two Cif-like epoxide hydrolases from Burkholderia cenocepacia. Cfl1 is able to hydrolyze xenobiotic as well as biological epoxides that might be encountered in the environment or during infection. In contrast, Cfl2 shows very low activity against a diverse set of epoxides. The crystal structures of the two proteins reveal quaternary structures that build on the well-known dimeric assembly of the α/β hydrolase domain, but broaden our understanding of the structural diversity encoded in novel oligomer interfaces. Analysis of the interfaces reveals both similarities and key differences in sequence conservation between the two assemblies, and between the canonical dimer and the novel oligomer interfaces of each assembly. Finally, we discuss the effects of these higher-order assemblies on the intra-monomer flexibility of Cfl1 and Cfl2 and their possible roles in regulating enzymatic activity.
Collapse
Affiliation(s)
- Noor M. Taher
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Kelli L. Hvorecny
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Cassandra M. Burke
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Morgan S.A. Gilman
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Gary E. Heussler
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Jared Adolf-Bryfogle
- Institute for Protein Innovation, Boston, MA, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Christopher D. Bahl
- Institute for Protein Innovation, Boston, MA, USA
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - George A. O'Toole
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Dean R. Madden
- Department of Biochemistry and Cell Biology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| |
Collapse
|
4
|
A Woman with Nonresolving Fever and Bilateral Pulmonary Infiltrates. Ann Am Thorac Soc 2020; 16:910-913. [PMID: 31259635 DOI: 10.1513/annalsats.201812-906cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
5
|
Fatal Septicemia and Mastitis in Wild Sunda Colugos (Sunda Flying Lemurs; Galeopterus variegates) in Singapore. J Wildl Dis 2020; 56:713-716. [PMID: 31917633 DOI: 10.7589/2019-07-187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Two free-ranging female Sunda colugos (Sunda flying lemur; Galeopterus variegates) were found dead in Singapore in November 2018 and February 2019. Septicemia and mastitis were diagnosed in both animals on postmortem examination. Infectious diseases have not previously been established as a cause of death in wild Sunda colugos.
Collapse
|
6
|
Lim BA, Lopez A, Buensalido JA. Refractory Burkholderia cepacia bacteraemia from a consolidation pneumonia lasting more than 7 weeks, successfully treated with systemic antibiotics and nebulised meropenem. BMJ Case Rep 2019; 12:12/8/e229566. [PMID: 31377717 DOI: 10.1136/bcr-2019-229566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of a 55-year-old Filipino man who was transferred from another institution where he was recently diagnosed with Crohn's disease but not started on any immunosuppressants. He underwent laparoscopic cholecystectomy with T-tube placement a few weeks prior to admission. On workup, abdominal CT scan was unremarkable, but blood cultures on the third hospital day grew Burkholderia cepacia Antibiotic regimen was shifted to ceftazidime and levofloxacin. The bacteraemia and febrile episodes persisted despite removal of the central line and T tube. White blood cell scan and chest CT scan showed left-sided consolidation pneumonia. Blood cultures continued to grow B. cepacia despite shifting to meropenem and trimethoprim-sulfamethoxazole. Meropenem nebulisation at 250 mg every 12 hours was added to the regimen on the third week then oral minocycline was added on the fourth week due to persistence of bacteraemia. He subsequently developed a small vegetation on the aortic valve, so amikacin was added. Fever lysed on the sixth week, but the B. cepacia bacteraemia persisted, clearing only on the 51st hospital day. The patient was discharged with a plan to continue antibiotics, including meropenem nebulisation, for 6 more weeks. On follow-up, the patient had no recurrence of fever. There was also resolution of consolidation on chest CT scan and disappearance of vegetation on echocardiography.
Collapse
Affiliation(s)
- Bryan Albert Lim
- Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Adelaine Lopez
- Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Joseph Adrian Buensalido
- Department of Medicine (Division of Infectious Diseases), University of the Philippines-Philippine General Hospital, Manila, Philippines
| |
Collapse
|
7
|
Ho SSC, Nashid N, Waters VJ, LiPuma JJ, Zlosnik JEA, Otley A, Somers GR, Kamath BM, Yau YCW. Burkholderia multivorans septicemia in a pediatric liver transplant patient. Am J Transplant 2019; 19:933-938. [PMID: 30091842 DOI: 10.1111/ajt.15065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 01/25/2023]
Abstract
"Cepacia syndrome", caused by Burkholderia cepacia complex and often associated with cystic fibrosis, carries a high mortality rate. It is rare for Burkholderia multivorans, a species within the B. cepacia complex, to cause cepacia syndrome even among patients with cystic fibrosis. This is the first reported fatal case of cepacia syndrome caused by B. multivorans occurring in a pediatric liver transplant recipient who does not have cystic fibrosis. We describe the unique characteristics of this pathogen among the non-cystic fibrosis population and the importance of early recognition and treatment.
Collapse
Affiliation(s)
- Shaun S C Ho
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Nashid
- Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Valerie J Waters
- Division of Infectious Diseases, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - John J LiPuma
- Department of Pediatrics and Communicable Disease, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James E A Zlosnik
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Otley
- Division of Gastroenterology & Nutrition, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gino R Somers
- Division of Pathology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Binita M Kamath
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Yvonne C W Yau
- Division of Microbiology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Datta P, Gupta M, Kumar MB, Gupta V, Chander J. Burkholderia Cepacia Complex Causing Pneumonia in an Immunocompetent Non-Cystic Fibrosis Patient: Case Report and Review of Literature. Infect Disord Drug Targets 2018; 20:106-110. [PMID: 30345929 DOI: 10.2174/1871526518666181022112857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause of opportunistic pulmonary infections, particularly in patients with Cystic Fibrosis (CF). The natural ecology of the bacteria as part of plant growth-promoting rhizosphere provides stark contrast to its infectious potential. Its preponderance as a nosocomial pathogen may be due to its ability to survive in antiseptic solutions, contaminate equipments and intrinsic antimicrobial resistance. CASE An elderly, diabetic male was evaluated for hemoptysis, fever and cough. Chest computed tomography showed a thick walled cavity in the left lung and hilar lymphadenopathy. Sputum examination showed Gram negative bacilli and no acid fast bacilli. Sputum culture yielded growth of non-fermentative Gram negative bacilli on two occasions, but blood culture was sterile. The isolate was identified as B. cepacia by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The patient's general condition remained poor and in spite of initiation of antibiotics, the patient expired after an episode of massive hemoptysis. CONCLUSION This report raises concerns regarding the spread and severity of B. cepacia infection in non-compromised patients in the community and the need to suspect and identify it. Since the organism is inherently resistant to antipseudomonal penicillins, aminoglycosides and polymyxin B, differentiation from Pseudomonas spp. and determining antimicrobial susceptibility is paramount for treatment.
Collapse
Affiliation(s)
- Priya Datta
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh 160030, India
| | - Menal Gupta
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh 160030, India
| | - Mani B Kumar
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh 160030, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh 160030, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College and Hospital, Sector-32, Chandigarh 160030, India
| |
Collapse
|
9
|
Abstract
A review of pulmonary infections of all types with diagnostic and morphological features.
Collapse
|
10
|
Cepacia Syndrome in a Non-Cystic Fibrosis Patient. Case Rep Infect Dis 2015; 2015:537627. [PMID: 26357579 PMCID: PMC4555446 DOI: 10.1155/2015/537627] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/03/2015] [Indexed: 11/29/2022] Open
Abstract
Burkholderia (formerly Pseudomonas) cepacia complex is a known serious threat to patients with cystic fibrosis, in whom it has the potential to cause the fatal combination of necrotizing pneumonia, worsening respiratory failure, and bacteremia, known as Cepacia syndrome. The potential for this pathogen to infect non-cystic fibrosis patients is limited and its epidemiology is poorly understood. Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions. We present a case of a 64-year-old man with Streptococcus pneumoniae community-acquired pneumonia whose hospital course was complicated by developing cavitary lung lesions, bacteremia, and acute respiratory distress syndrome. Repeated tracheal aspirate and blood cultures grew Burkholderia cepacia. Our case appears to be the first report of Cepacia syndrome in a patient without cystic fibrosis. This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome. A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.
Collapse
|
11
|
Isolation and characterization of "Pseudomonas andersonii" from four cases of pulmonary granulomas and emended species description. J Clin Microbiol 2011; 49:1518-23. [PMID: 21270229 DOI: 10.1128/jcm.02219-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
"Pseudomonas andersonii" is a Gram-negative bacillus initially isolated from a granulomatous lung lesion. Novel species status has not been validated for this single strain. We report four additional cases of pulmonary granuloma involving P. andersonii and further characterize the organism. These patients had pulmonary nodules that were surgically resected and which grew P. andersonii on routine culture. Mycobacterium avium complex was concomitantly isolated in two cases, and fungal structures were identified histopathologically in two other cases. The five P. andersonii strains described to date were similar in growth characteristics, biochemical reactions, matrix-assisted laser desorption ionization-time of flight mass spectrometry protein profiles, and susceptibility to antimicrobial agents. Their 16S rRNA genes were 99.9 to 100% identical but less than 95.0% similar to those of all other known bacteria. The gyrA genes of these strains were 99.5 to 100% identical. These shared features illustrate P. andersonii as a unique and distinct bacterium and support the novel species status of the organism.
Collapse
|
12
|
|
13
|
|
14
|
Simmonds NJ, Gyi KM. Cystic fibrosis, a Burkholderia cenocepacia chest wall abscess and rapid clinical deterioration. J R Soc Med 2008; 101 Suppl 1:S46-50. [PMID: 18607020 DOI: 10.1258/jrsm.2008.s18011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- N J Simmonds
- Department of Cystic Fibrosis, Royal Brompton Hospital Sydney Street, London SW3 6NP, UK.
| | | |
Collapse
|
15
|
Abstract
In Osier’s time, bacterial pneumonia was a dreaded event, so important that he borrowed John Bunyan’s characterization of tuberculosis and anointed the pneumococcus, as the prime pathogen, “Captain of the men of death.”1 One hundred years later much has changed, but much remains the same. Pneumonia is now the sixth most common cause of death and the most common lethal infection in the United States. Hospital-acquired pneumonia is now the second most common nosocomial infection.2 It was documented as a complication in 0.6% of patients in a national surveillance study,3 and has been reported in as many as 20% of patients in critical care units.4 Furthermore, it is the leading cause of death among nosocomial infections.5 Leu and colleagues6 were able to associate one third of the mortality in patients with nosocomial pneumonia to the infection itself. The increase in hospital stay, which averaged 7 days, was statistically significant. It has been estimated that nosocomial pneumonia produces costs in excess of $500 million each year in the United States, largely related to the increased length of hospital stay.
Collapse
|
16
|
Abstract
Granulomas in the lung are common diagnostic problems encountered by pathologists. They occur in a wide range of pulmonary conditions, ranging from common entities to uncommon ones and including both infections and non-infectious diseases. This review summarizes the main histological features that help distinguish various granulomatous lung diseases. It concentrates on the most important and common entities that may be encountered and emphasizes helpful features in the differential diagnosis.
Collapse
Affiliation(s)
- O A El-Zammar
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY 13210, USA
| | | |
Collapse
|
17
|
George RB, Cartier Y, Casson AG, Hernandez P. Suppurative mediastinitis secondary to Burkholderia cepacia in a patient with cystic fibrosis. Can Respir J 2006; 13:215-8. [PMID: 16779467 PMCID: PMC2683282 DOI: 10.1155/2006/495720] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Burkholderia cepacia is an important opportunistic pathogen among patients with cystic fibrosis (CF); it is associated with deterioration of lung function, poor outcome following lung transplantation and increased mortality. Fever, an elevated white blood cell count, weight loss and an often fatal deterioration in pulmonary function characterize a particular clinical course, termed "Cepacia syndrome". The present case report describes a 40-year-old man with CF who developed Cepacia syndrome complicated by suppurative mediastinitis, from which B cepacia was isolated. Despite optimal medical and surgical therapy, this patient succumbed to his illness. Those caring for patients with CF should be aware of this potentially catastrophic complication of B cepacia infection, especially in the setting of Cepacia syndrome.
Collapse
Affiliation(s)
- Ronald B George
- Department of Anesthesia, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
| | - Yannick Cartier
- Department of Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
| | - Alan G Casson
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
| | - Paul Hernandez
- Division of Respirology, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia
- Correspondence: Dr Paul Hernandez, Division of Respirology, Room 4458, Halifax Infirmary, Queen Elizabeth II Health Sciences Centre, 1796 Summer Street, Halifax, Nova Scotia B3H 3A7. Telephone 902-473-3698, fax 902-473-6202, e-mail
| |
Collapse
|
18
|
Ghazal SS, Al-Mudaimeegh K, Al Fakihi EM, Asery AT. Outbreak of Burkholderia cepacia bacteremia in immunocompetent children caused by contaminated nebulized sulbutamol in Saudi Arabia. Am J Infect Control 2006; 34:394-8. [PMID: 16877110 DOI: 10.1016/j.ajic.2006.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND An outbreak of 5 inpatient and otherwise healthy children admitted for respiratory problems developed dry fever and cough after a few days of hospitalization. Burkhuldaria cepacia was isolated from their blood culture. The Infection Control Department (ICD) in the King Fahad Medical City (KFMC) detected and investigated the outbreak to identify the source of the organism and mode of transmission. METHODS After the initial review of all the existing records in the KFMC, log book of the laboratory, and direct questioning of all physicians and revising the method of B cepacia identification in our laboratory, an observational study to identify any violation of infection control policy and a case-control study were designed to identify possible risk factors associated with the occurrence and transmission of the disease. RESULTS A total of 7 healthy patients were reported to have B cepacia-positive blood culture, with 5 patients infected in the KFMC and 2 patients in their referring hospitals. We could isolate the same organism from sulbutamol solution 0.5% manufactured locally (Vintec). Among the risk factors studied, concomitant use of nebulized budesonide with sulbutamol (OR, 26; 95% CI: 1.31-1,187) was found to be 26 times more likely to be associated with infection and to be statistically significant; concomitant use of systemic hydrocortisone increased the risk of infection 4 times but, statistically, was not significant. No significant association was found with concomitant syncitial respiratory virus (RSV) infections or having chronic diseases. None of the affected patients were found to be immunocompromised. CONCLUSION B cepacia can affect healthy children. Contaminated nebulized sulbutamol with B cepacia was the source of infection, and inhalation was the mode of transmission. Concomitant use of nebulized budesonide solution is a significant risk factor. The KFMC was the first health institution to diagnose this national outbreak.
Collapse
Affiliation(s)
- Sameeh S Ghazal
- Department of Infection Control and Environmental Health Administration, King Fahad Medical City, Riyadh, Saudi Arabia.
| | | | | | | |
Collapse
|
19
|
Held MR, Begier EM, Beardsley DS, Browne FA, Martinello RA, Baltimore RS, McDonald LC, Jensen B, Hadler JL, Dembry LM. Life-threatening sepsis caused by Burkholderia cepacia from contaminated intravenous flush solutions prepared by a compounding pharmacy in another state. Pediatrics 2006; 118:e212-5. [PMID: 16785290 DOI: 10.1542/peds.2005-2617] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report 2 life-threatening cases of Burkholderia cepacia sepsis caused by infusate contamination during compounding. Bacterial isolates from the patients' blood cultures and the infusate were indistinguishable by pulsed-field gel electrophoresis. Proper quality controls at a local and national level are important for ensuring safe delivery of compounded medications to patients in all settings, including those outside health care facilities.
Collapse
Affiliation(s)
- Melissa R Held
- Department of Pediatrics, Division of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
We report the case of an adult with Crohn's disease and pulmonary sarcoidosis on the background of cystic fibrosis (CF). There is a recognized association between Crohn's colitis and CF, but cases of pulmonary sarcoidosis in CF are rare. There may be a pathogenic link between the two granulomatous disorders and CF with chronic immune stimulation leading to hyperimmunoglobulinemia, circulating immune complexes and subsequent granuloma formation.
Collapse
Affiliation(s)
- Catherine J Dobbin
- Department of Respiratory Medicine, E 11 South, Royal Prince Alfred Hospital, Missenden Road, Camperdown NSW 2050, Australia
| | | | | |
Collapse
|
21
|
Sajjan U, Thanassoulis G, Cherapanov V, Lu A, Sjolin C, Steer B, Wu YJ, Rotstein OD, Kent G, McKerlie C, Forstner J, Downey GP. Enhanced susceptibility to pulmonary infection with Burkholderia cepacia in Cftr(-/-) mice. Infect Immun 2001; 69:5138-50. [PMID: 11447196 PMCID: PMC98610 DOI: 10.1128/iai.69.8.5138-5150.2001] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Progressive pulmonary infection is the dominant clinical feature of cystic fibrosis (CF), but the molecular basis for this susceptibility remains incompletely understood. To study this problem, we developed a model of chronic pneumonia by repeated instillation of a clinical isolate of Burkholderia cepacia (genomovar III, ET12 strain), an opportunistic gram-negative bacterium, from a case of CF into the lungs of Cftr (m1unc-/-) (Cftr(-/-)) and congenic Cftr(+/+) controls. Nine days after the last instillation, the CF transmembrane regulator knockout mice showed persistence of viable bacteria with chronic severe bronchopneumonia while wild-type mice remained healthy. The histopathological changes in the lungs of the susceptible Cftr(-/-) mice were characterized by infiltration of a mixed inflammatory-cell population into the peribronchiolar and perivascular spaces, Clara cell hyperplasia, mucus hypersecretion in airways, and exudation into alveolar airspaces by a mixed population of macrophages and neutrophils. An increased proportion of neutrophils was observed in bronchoalveolar lavage fluid from the Cftr(-/-) mice, which, despite an increased bacterial load, demonstrated minimal evidence of activation. Alveolar macrophages from Cftr(-/-) mice also demonstrated suboptimal activation. These observations suggest that the pulmonary host defenses are compromised in lungs from animals with CF, as manifested by increased susceptibility to bacterial infection and lung injury. This murine model of chronic pneumonia thus reflects, in part, the situation in human patients and may help elucidate the mechanisms leading to defective host defense in CF.
Collapse
Affiliation(s)
- U Sajjan
- Research Institute, The Hospital for Sick Children, Toronto, Ontario M5G 1X8
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|