Elizabethkingia miricola as an opportunistic oral pathogen associated with superinfectious complications in humoral immunodeficiency: a case report

Abstract

Background Elizabethkingia miricola is a rare Gram-negative bacterium found in water and clinical specimens. Typical culturing methods often misidentify Elizabethkingia spp. as Flavobacterium or Chryseobacterium. Although diagnosis is based on culturing samples taken from sterile sites, such as blood, a proper identification of this bacterium requires an expertise that goes beyond the capabilities of a typical clinical laboratory.Case presentationA 35-year-old woman diagnosed with common variable immunodeficiency was admitted to our center. Previous treatment with antibiotics (amoxicillin plus clavulanate, first and third generation of cephalosporins, macrolides) and systemic corticosteroids (up to 120 mg/day of prednisolone) failed to arrest the spread of inflammation. Gingival recession was observed in her oral cavity, resulting in an apparent lengthening of her teeth. In addition to typical commensal bacteria, including streptococci and neisseriae, strains of Rothia mucilaginosa and Elizabethkingia miricola were identified upon a detailed microbiological examination using a MALDI-TOF MS Biotyper system. The presence of the latter strain correlated with severe periodontitis, lack of IgA in her saliva and serum, a very low IgG concentration (< 50 mg/dl), IgM-paraproteinemia, decreases in C3a and C5a and microvascular abnormality. High-dose immunoglobulin (to maintain IgG > 500 mg/dl) and targeted levofloxacin treatment resulted in immune system reconstitution, oral healing, and eradication of the Elizabethkingia infection.Conclusions E. miricola rarely causes disease in healthy individuals. However, the overgrowth of commensal bacteria, lack of IgG/IgA, microvasculopathy and complement cascade activation in patients with humoral immunodeficiency may facilitate Elizabethkingia invasion. Overuse of antibiotics, particularly beta-lactams, may cause mucosal colonization by E. miricola, followed by its multiplication combined with periodontitis that prompts bacterial translocation. MALDI-TOF Biotyper analysis may become a method of choice for identification of Elizabethkingia infections.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2886-7) contains supplementary material, which is available to authorized users.

Elizabethkingia Infections in Humans: From Genomics to Clinics

“…E. miricola has been sporadically reported to cause pneumonia, bacteremia, urinary tract infection, and periodontitis since its first proposal as a new species in 2003 [60,61,62,63]. A retrospective South Korean study reported that the annual incidence of E. miricola increased from 0 to 0.22 per 1000 admissions from 2009–2016 [17].…”

Genomic analysis of Elizabethkingia species from aquatic environments: Evidence for potential clinical transmission

“…The majority of Australian aquatic environment isolates from this study were E. miricola. E. miricola is known to cause sepsis, oral and urinary tract infections ( Green et al., 2008 ; Lin et al., 2019a ; Zdziarski et al., 2017 ) though reports of infection are less frequent than that for E. meningoseptica and E. anophelis . Environmental E. miricola from this study formed two distinct clades.…”

Comparative Metagenomics Reveals Microbial Signatures of Sugarcane Phyllosphere in Organic Management

“…Conventional-specific taxa comprised of metal-mobilizing Metallosphaera cuprina ( Liu et al, 2011 ), environmental extremes-resistant Halorubrum sp. BOL3-1 ( DasSarma et al, 2019 ), and human pathogenic bacteria such as Elizabethkingia miricola ( Zdziarski et al, 2017 ), and Mycolicibacterium smegmatis ( Yamada et al, 2018 ). Organic-specific taxa consisted of plant growth-promoting bacteria including N 2 -fixing bacteria [i.e., Mesorhizobium loti ( Shimoda et al, 2016 ) and Bradyrhizobium sp.…”