Disseminated Burkholderia gladioli infection in a lung transplant recipient with underlying hypocomplementemic urticarial vasculitis

Abstract

Burkholderia gladioli is difficult to definitively identify within the laboratory using phenotypic testing alone. We describe a case of recurrent B. gladioli infection in a lung transplant recipient with underlying hypocomplementemic urticarial vasculitis syndrome, discuss the difficulties encountered with laboratory identification, provide a review of the methodology required for definitive identification, and discuss potential pathophysiologic mechanisms in this patient responsible for the difficulty in treatment.

Fatal Case ofBurkholderia gladioliPneumonia in a Patient With COVID-19

“… 4 One case report showed that a reduction of immunosuppression combined with antimicrobials led to clearance of B gladioli infection but ultimately led to the patient's death from an invasive fungal infection of the lungs. 20 Infection with this bacterium is often associated with a poor prognosis, as with our patient. 20 …”

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes

“…50 Despite the growing prevalence of automated microbial identification instruments, there are still ongoing problems with accurate identification of members of the Burkholderia family in clinical settings that have been outlined in several studies regarding B. gladioli. 51,52 It is crucial that clear differentiation of species is achieved, due to the range of outcomes attributable to each different member of this complex of organisms.…”

“…Despite resolution of B. gladioli infection, the patient ultimately succumbed to a fatal pulmonary Aspergillus infection. 52 These cases suggest that extended, strong antibiotic use may alter the underlying bacterial composition of the lung, in an attempt to treat B. gladioli infection, and thus leave patients susceptible to pulmonary infection with fungal and viral species. Further studies to determine the mechanisms underlying this phenomenon should prove useful in guiding future treatment decision-making.…”