Rare coexistence of disease or pathology Background:Bacterial Infections, especially, of the respiratory system, have been reported as one of the medical concerns in patients with the Coronavirus Disease-2019 (COVID-19), particularly those with multiple co-morbidities. We present a case of a diabetic patient with co-infection of multi-drug-resistant Kocuria rosea and methicillin-resistant Staphylococcus aureus (MRSA) who contracted COVID-19. Case Report:A 72-year-old man with diabetes presented with symptoms including cough, chest pain, urinary incontinence, respiratory distress, sore throat, fever, diarrhea, loss of taste, and anosmia and was confirmed to have COVID-19. At admission, he was also found to have sepsis. MRSA was isolated in conjunction with another organism, resembling coagulase-negative Staphylococcus, which was misidentified using commercial biochemical testing systems. The strain was finally confirmed to be Kocuria rosea by 16S rRNA gene sequencing. Both strains were highly resistant to multiple classes of antibiotics, but the Kocuria rosea was resistant to all the cephalosporins, fluoroquinolones, and macrolides tested. The use of ceftriaxone and ciprofloxacin did not improve his condition, which ultimately led to his death. Conclusions:This case report shows that the presence of multi-drug-resistant bacteria infections can be fatal in patients with COVID-19, especially in patients with other co-morbidities like diabetes. This case report also shows that biochemical testing may be inadequate in identifying emerging bacterial infections and there is a need to include proper bacterial screening and treatment in the management of COVID-19, especially in patients with other co-morbidities and with indwelling devices.
Burkholderia is a genus comprising Gram-negative bacteria that are metabolically complex and versatile, thriving in frequently hostile settings. Burkholderia pseudomallei, the causative agent of melioidosis, is a prominent member of the genus and a clinical pathogen of tropical and sub-tropical regions. This pathogen is well known for its multidrug resistance nature and possible bioweapon potential. There is currently no report of the pathogen from clinical specimens in Nigeria, this might be due to misdiagnosis with phenotypic assays. This study aims to explore the accuracy in the use of phenotypic assays to accurately diagnose B. pseudomallei in Nigeria. Two hundred and seventeen (217) clinical samples and twenty-eight (28) Gram-negative clinical isolates were collected and analysed using Ashdown selective agar and monoclonal antibody-based latex agglutination. The species-level identification was achieved using the Analytical profile index (API) 20NE system. The susceptibility of the isolates to nine different antimicrobial agents was determined using the disk diffusion method. Sixty-seven (74) culture-positive isolates were obtained using Ashdown selective agar. Twenty-two isolates were believed to be B. pseudomallei through the monoclonal antibody-based latex agglutination test and API 20NE system subsequently identified 14 isolates as Burkholderia. The predominant Burkholderia species was B. cepacia with isolation rate of 30.8% (8/26). No isolate was distinctively identified as B. pseudomallei but five isolates were highly suspected to be B. pseudomallei with similarity indices ranging from 81.9 – 91.3%. Other bacterial species with definitive identity include Aeromonas sp., Sphingomonas sp. and Pseudomonas aeruginosa. The antibiotic susceptibility results revealed an overall resistance to amoxicillin-clavullanic acid (71.4%), cefepime (33.3%), trimethoprim-sulfamethoxazole (38.1%), piperacillin-tazobactam (33.3%), imipenem (66.7%), doxycycline (57.1%), and ceftazidime (66.7%). The highest intermediate resistance was observed for cefepime and piperacillin-tazobactam with a value 66.7% each while no intermediate-resistance for gentamicin, colistin and imipenem. Our findings, therefore, show that phenotypic assays alone are not enough in the diagnosis of melioidosis. Additionally, it provides a robust basis for supporting present and future decisions to expand diagnostic capability for melioidosis beyond phenotypic assays in low-resource settings.
Burkholderia is a genus comprising Gram-negative bacteria that are metabolically complex and versatile, thriving in frequently hostile settings. Burkholderia psudomallei, the causative agent of melioidosis, is a prominent member of the genus and a clinical pathogen of tropical and sub-tropical regions. This pathogen is well known for its multidrug resistance nature and possible bioweapon potential. There are currently limited reports of this pathogen from clinical specimens in Nigeria. This study aimed to determine the occurrence of B. pseudomallei in clinical settings and characterize the pathogen using phenotypic means. Two hundred and seventeen (217) clinical samples and twenty-eight (28) Gram-negative clinical isolates were collected and analysed using Ashdown selective agar and monoclonal antibody based-latex agglutination. The species-level identification was achieved using the Analytical profile index (API) 20NE system. The susceptibility of the isolates to nine different antimicrobial agents was determined using the disk diffusion method. Sixty-seven (67) culture-positive isolates were obtained using Ashdown selective agar. Twenty-six isolates were believed to be B. pseudomallei through the monoclonal antibody based-latex agglutination test and API 20NE system subsequently identified 14 isolates as Burkholderia. The predominant Burkholderia species was B. cepacia with isolation rate of 26.9% (7/26). No isolate was distinctively identified as B. pseudomallei but four isolates were highly suspected to be B. pseudomallei with similarity indices ranging from 81.9 – 91.3%. Other bacterial species with definitive identity include Aeromonas sp., Sphingomonas sp. and Pseudomonas aeruginosa. The antibiotic susceptibility results revealed an overall resistance to amoxicillin-clavullanic acid (71.4%), cefepime (33.3%), trimethoprim-sulfamethoxazole (38.1%), piperacillin-tazobactam (33.3%), imipenem (66.7%), doxycycline (57.1%), and ceftazidime (66.7%). The highest intermediate resistance was observed for cefepime and piperacillin-tazobactam with a value 66.7% each while no intermediate-resistance for gentamicin, colistin and imipenem. Our findings, therefore, provide a robust basis for not just supporting present and future decisions for expanding diagnostic capability for Burkholderia, but also for investigating the relevance of the pathogens in clinical situations.
Intranasal sprays containing Bacillus species are being researched for treating viral respiratory tract infections. The aim of this study was to assess the relationship between the nasal carriage ofBacillusand COVID-19 severity. This was a cross-sectional study that collected nasopharyngeal samples from adults 18 years and above visiting two COVID-19 testing centers in Lagos, Nigeria between September 2020 and September 2021. Bacillus species were cultured from the respiratory samples and confirmed using molecular methods. The dependent variable was COVID-19 status classified as negative, asymptomatic, mild, or severe. The independent variable was the nasal carriage of Bacillus species. Multinomial regression analysis was done to determine the association between nasal carriage of Bacillus and COVID-19 severity after adjusting for age, sex, and co-morbidity status. About 388 participants were included in the study with a mean (standard deviation) age of 40.05 (13.563) years. The majority (61.1%) of the participants were male, 100 (25.8%) had severe COVID-19, 130 (33.5%) had pre-existing comorbidity, and 76 (19.6%) had Bacillus cultured from their nasopharyngeal specimen. Bacillus species presence was significantly associated with higher odds of severe COVID-19 compared to having a negative COVID-19 status. However, the presence of Bacillus species was significantly associated with lower odds of severe COVID-19 compared to having a mild COVID-19 status. The study suggests that nasal carriage of Bacillus species may substantially impact the clinical course of COVID-19. This study supports the exploration ofBacillusspecies in the prevention and management of viral respiratory tract infections.
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