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Bansie R, Harkisoen S, Lachman V, Lai A Fat E, Ramdhani N, van Laar JAM. A rare infection in the tropics that is not uncommon in cases of chronic granulomatous disease. Access Microbiol 2019; 1:e000039. [PMID: 32974549 PMCID: PMC7470406 DOI: 10.1099/acmi.0.000039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/17/2019] [Indexed: 12/12/2022] Open
Abstract
Chromobacterium violaceum is a rare cause of infection in immunocompromised patients in the tropics with a spectrum of disease manifestations, including severe disease. Early identification of this micro-organism is essential for appropriate management. We present a case of C. violaceum septicaemia in a patient with chronic granulomatous disease.
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Affiliation(s)
- Rakesh Bansie
- Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Soeradj Harkisoen
- Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Varsha Lachman
- Department of Internal Medicine, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Esther Lai A Fat
- Department of Dermatology, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Navin Ramdhani
- Intensive Care Unit, Academic Hospital Paramaribo, Paramaribo, Suriname
| | - Jan A M van Laar
- Departments of Clinical Immunology and Internal Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Schroder̈ A, Gerin A, Firth GB, Hoffmann KS, Grieve A, von Sochaczewski CO. A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018. BMC Infect Dis 2019; 19:317. [PMID: 30975101 PMCID: PMC6458701 DOI: 10.1186/s12879-019-3941-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 03/28/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy. METHODS We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched 'PubMed', 'Web of Science' and 'SCOPUS' for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes. RESULTS We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries. CONCLUSIONS Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits.
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Affiliation(s)
- Arne Schroder̈
- Klinik für Anästhesiologie und Intensivmedizin, Marienkrankenhaus Bergisch-Gladbach, Dr.-Robert-Koch-Straße 18, Bergisch-Gladbach, D-51465 Germany
| | - Aurelié Gerin
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Johannesburg, ZA-1860 South Africa
| | - Gregory B. Firth
- Department of Orthopaedic Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Johannesburg, ZA-1860 South Africa
| | - Kelly S. Hoffmann
- Department of Paediatric Surgery, Universitair Medisch Centrum Groningen, Hanzeplein 1, Groningen, NL-9713 The Netherlands
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Johannesburg, ZA-1860 South Africa
| | - Andrew Grieve
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Johannesburg, ZA-1860 South Africa
| | - Christina Oetzmann von Sochaczewski
- Department of Paediatric Surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, 26 Chris Hani Road, Johannesburg, ZA-1860 South Africa
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, Mainz, D-55131 Germany
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Action and function of Chromobacterium violaceum in health and disease: Violacein as a promising metabolite to counteract gastroenterological diseases. Best Pract Res Clin Gastroenterol 2017; 31:649-656. [PMID: 29566908 DOI: 10.1016/j.bpg.2017.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 10/10/2017] [Indexed: 01/31/2023]
Abstract
Chromobacterium violaceum is a Gram negative, β-proteobacterium found in the microbiota of tropical and subtropical environments. Although considered an opportunistic pathogen, infection rapidly progress to fatal sepsis, with metastatic abscesses. It is noteworthy the multidrug resistant phenotype of C. violaceum and the possibility of relapse. Recently, an influence of global climate in the incidence of cases beyond the previous areas has been observed. Furthermore, chronic granulomatous disease has been considered a risk factor to infection. Despite the increase in C. violaceum infection incidence and high mortality, most clinicians are not familiar with it. This review pointed out important features of this life threatening microorganism, including its pathogenicity, mechanistic aspects, genetic and drug resistance associated factors, and the clinical association with chronic granulomatous disease. In addition, its main metabolite violacein may be a promising agent to counteract gastroenterological diseases, such as colorectal cancer and inflammatory gastric lesions.
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Meher-Homji Z, Mangalore RP, D R Johnson P, Y L Chua K. Chromobacterium violaceum infection in chronic granulomatous disease: a case report and review of the literature. JMM Case Rep 2017; 4:e005084. [PMID: 28348801 PMCID: PMC5361631 DOI: 10.1099/jmmcr.0.005084] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/09/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction.Chromobacterium violaceum is an opportunistic human pathogen, associated with significant mortality, and has been reported in patients with chronic granulomatous disease (CGD), a genetic condition causing impaired phagocytosis. Case presentation. A 28-year-old man with a history of CGD presented with fever, pharyngitis, cervical lymphadenopathy and internal jugular vein thrombosis, following travel to the rural Solomon Islands. C. violaceum was recovered from his blood. The patient recovered after treatment with meropenem and trimethoprim/sulfamethoxazole. Conclusion. To the best of our knowledge, this is the first case report of internal jugular vein thrombophlebitis (Lemierre’s syndrome) caused by C. violaceum in a patient with CGD. A review of the literature demonstrated that the diagnosis of C. violaceum preceded the diagnosis of CGD in the majority of cases. This case emphasizes the importance of this organism in patients with CGD who live in or visit tropical areas.
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Affiliation(s)
- Zaal Meher-Homji
- Department of Infectious Diseases, Austin Health , Heidelberg, VIC 3084 , Australia
| | - Rekha Pai Mangalore
- Department of Infectious Diseases, Austin Health , Heidelberg, VIC 3084 , Australia
| | - Paul D R Johnson
- Department of Infectious Diseases, Austin Health , Heidelberg, VIC 3084 , Australia
| | - Kyra Y L Chua
- Department of Infectious Diseases, Austin Health, Heidelberg, VIC 3084, Australia; Department of Microbiology, Austin Health, Heidelberg, VIC 3084, Australia
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Durán N, Justo GZ, Durán M, Brocchi M, Cordi L, Tasic L, Castro GR, Nakazato G. Advances in Chromobacterium violaceum and properties of violacein-Its main secondary metabolite: A review. Biotechnol Adv 2016; 34:1030-1045. [PMID: 27288924 DOI: 10.1016/j.biotechadv.2016.06.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 12/22/2022]
Abstract
Chromobacterium violaceum is important in the production of violacein, like other bacteria, such as Alteromonas, Janthinobacterium, Pseudoalteromonas, Duganella, Collimonas and Escherichia. Violacein is a versatile pigment, where it exhibits several biological activities, and every year, it shows increasing commercially interesting uses, especially for industrial applications in cosmetics, medicines and fabrics. This review on violacein focuses mainly on the last five years of research regarding this target compound and describes production and importance of quorum sensing in C. violaceum, mechanistic aspects of its biosynthesis, monitoring processes, genetic perspectives, pathogenic effects, antiparasitic and antimicrobial activities, immunomodulatory potential and uses, antitumor potential and industrial applications.
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Affiliation(s)
- Nelson Durán
- Institute of Chemistry, Biological Chemistry Laboratory, University of Campinas, CP 6154, CEP 13083-970 Campinas, SP, Brazil; NanoBioss, Institute of Chemistry, University of Campinas, Campinas, SP, Brazil; LNNano (CNPEM) Campinas, SP, Brazil.
| | - Giselle Z Justo
- Department of Cell Biology and Department of Biochemistry, Federal University of São Paulo (UNIFESP-Diadema), SP, Brazil
| | - Marcela Durán
- NanoBioss, Institute of Chemistry, University of Campinas, Campinas, SP, Brazil; Institute of Biology, Urogenital, Carcinogenesis and Immunotherapy Laboratory, University of Campinas, SP, Brazil
| | - Marcelo Brocchi
- Institute of Biology, Department Genetics, Evolution and Bioagents, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Livia Cordi
- NanoBioss, Institute of Chemistry, University of Campinas, Campinas, SP, Brazil; Institute of Biology, Department Genetics, Evolution and Bioagents, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Ljubica Tasic
- Institute of Chemistry, Biological Chemistry Laboratory, University of Campinas, CP 6154, CEP 13083-970 Campinas, SP, Brazil; NanoBioss, Institute of Chemistry, University of Campinas, Campinas, SP, Brazil
| | - Guillermo R Castro
- Nanobiomaterials Laboratory, Applied Biotechnology Institute (CINDEFI, UNLP-CONICET CCT La Plata) - School of Sciences, Universidad Nacional de La Plata, La Plata, Argentina
| | - Gerson Nakazato
- Department of Microbiology, Biology Sciences Center, Londrina State University (UEL), Londrina, Brazil
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Lin YD, Majumdar SS, Hennessy J, Baird RW. The Spectrum of Chromobacterium violaceum Infections from a Single Geographic Location. Am J Trop Med Hyg 2016; 94:710-6. [PMID: 26903614 DOI: 10.4269/ajtmh.15-0862] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/09/2016] [Indexed: 11/07/2022] Open
Abstract
Chromobacterium violaceum is a bacterium associated with soil and water exposure in tropical regions and causes rare and serious clinical infections that are often fatal. We reviewed the demographic and clinical details of 28 patients with C. violaceum detected over 15 years from 2000 to 2015, from the Top End of the Northern Territory. Of these patients, 18 had infections attributable toC. violaceum Patients with infections were more commonly male (55.6%), and in the 16- to 60-year (61.1%) age group. Skin and soft tissue infections (50%), predominantly involving the limbs, were the major clinical manifestation. Water, mud exposure, and trauma were all noted as precipitating circumstances and comorbidities were present in 61.1% of the patients with infections. Of the 28 patients, 10 (35.8%) had C. violaceum isolated as an incidental finding or as asymptomatic colonization; these 10 patients did not require or receive therapy for C. violaceum bacterial infections. There were no relapsing infections in this group.Chromobacterium violaceum remains a serious infection, with seven patients (25%) in our series requiring intensive care management. However, the mortality rate (7.1%) in our series was far lower than previously described. This case series of C. violaceum infections from a single geographic area provides additional information of the characteristics of infection with this pathogen.
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Affiliation(s)
- Yi dan Lin
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, Darwin, Australia; Burnet Institute, Victoria, Australia
| | - Suman S Majumdar
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, Darwin, Australia; Burnet Institute, Victoria, Australia
| | - Jann Hennessy
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, Darwin, Australia; Burnet Institute, Victoria, Australia
| | - Robert W Baird
- Department of Microbiology, Territory Pathology, Royal Darwin Hospital, Darwin, Australia; Burnet Institute, Victoria, Australia
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Richard KR, Lovvorn JJ, Oliver SE, Ross SA, Benner KW, Kong MYF. Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:740-4. [PMID: 26477750 PMCID: PMC4614536 DOI: 10.12659/ajcr.894509] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Male, 11 Final Diagnosis: Chromobacterium violaceum infection Symptoms: Abscess • fever • rash Medication: — Clinical Procedure: ECMO Specialty: Critical Care Medicine
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Affiliation(s)
- Kathleen R Richard
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua J Lovvorn
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sara E Oliver
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon A Ross
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kim W Benner
- McWhorter School of Pharmacy, Samford University, Birmingham, AL, USA
| | - Michele Y F Kong
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Okada M, Inokuchi R, Shinohara K, Matsumoto A, Ono Y, Narita M, Ishida T, Kazuki C, Nakajima S, Yahagi N. Chromobacterium haemolyticum-induced bacteremia in a healthy young man. BMC Infect Dis 2013; 13:406. [PMID: 24004824 PMCID: PMC3766243 DOI: 10.1186/1471-2334-13-406] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022] Open
Abstract
Background The genus Chromobacterium consists of 7 recognized species. Among those, only C. violaceum, commonly found in the soil and water of tropical and subtropical regions, has been shown to cause human infection. Although human infection is rare, C. violaceum can cause life-threatening sepsis, with metastatic abscesses, most frequently infecting those who are young and healthy. Case presentation We recently identified a case of severe bacteremia caused by Chromobacterium haemolyticum infection in a healthy young patient following trauma and exposure to river water, in Japan. The patient developed necrotizing fasciitis that was successfully treated with a fasciotomy and intravenous ciprofloxacin and gentamicin. Conclusions C. haemolyticum should be considered in the differential diagnosis of skin lesions that progressively worsen after trauma involving exposure to river or lake water, even in temperate regions. Second, early blood cultures for the isolation and identification of the causative organism were important for initiating proper antimicrobial therapy.
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Affiliation(s)
- Megumi Okada
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, 963-8558 Koriyama, Fukushima, Japan
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