Bacteremia due to Kocuria rosea in a HIV positive patient with low CD4 count: A case report

Abstract

Introduction: Gender Kocuria includes 11 species, of which to date only K. rosea varians K. and K. kristinae, are pathogenic, although infrequently cause disease in immunocompromised patient Materials and Methods: The blood sample was collected from the patient and inoculated into the BrainHeart infusion biphasic media and after positive growth it was subjected to phenotypic identified by Vitek-2. Objectives: To detect the presence of systemic blood stream infection in the immunocompromised patient.Results: There was positive growth on the Brain Heart biphasic media and then when it was subjected to Vitek-2 it was found to be Kocuria rosea with 97% probability and excellent identification confidence Conclusions:The present case signifies the importance of Kocuria rosea as a important cause of bacteremia in immunocompromised patients though it is very rare. Keywords: Blood stream infection, immunocompromised, bacteremia I.Case report:A 42 yr old HIV positive male on 2 nd line ART with present CD 4 cell count of 62 cells/µl on the date of examination presented with fever and weakness of all the four limbs and oral lesions in the out patient dept of Regional Institute of Medical Sciences Hospital, Imphal following which he was admitted for further investigations and treatment. He was confirmed as HIV positive 8 months back. The patient had non productive cough for one year with weight loss and white patchy oral lesions. All other examinations conducted revealed normal clinical parameters. There was no other major complaints suggestive of pulmonary, cardiovascular, gastrointestinal, genitourinary systems involvement. Patient is neither hypertensive nor diabetic. 5ml of venous blood from antecubital vein was collected under strict aseptical precautions by the use of both rectified spirit and povidone iodine and was cultured on brain heart infusion biphasic media. Subculture was done on alternate days from the BHI biphasic media by tilting of the bottle and to see for any growth. On the fifth day salmon pink coloured growth was observed on the slant and increase in turbidity in the broth (Fig.1) following which it was subcultured on 5% sheep blood agar and Mac Conkey agar. The plates were incubated at 35°C for 48 h. On blood agar the colony was smooth, shiny, circular, entire and pink and non hemolytic. (Fig.2) There was no growth on Mac Conkey . On further examination of the growth on blood agar it, was found to be gram positive cocci arranged in tetrads on gram staining (Fig.3), non acid fast, were non-hemolytic on blood agar, catalase positive, coagulase negative, oxidase negative, urease negative, bile insoluble, lactose and mannitol not fermented and were non motile. Further identification was performed using the Biomerieux Vitek 2 system (GPI card) in which the organism was identified as Kocuria rosea with excellent identification confidence level and 97% probability; however, the alternative means of identification 16s rRNA sequencing was not performed. Culture of the oral swab from the whitish oral l...