First Report of Sphingomonas koreensis as a Human Pathogen in a Patient with Meningitis

Abstract

c Sphingomonas koreensis is an aerobic Gram-negative rod originally described in 2001 following isolation from natural mineral water in Korea. Here, we report a case study with Sphingomonas koreensis as the causative agent of meningitis. To our knowledge, this is the first documented case of Sphingomonas koreensis as a human pathogen. CASE REPORT In 1997, a 14-year-old female patient underwent surgery due to a syrinx in the cervical portion of her medulla. A cystoperitoneal shunt system was inserted, and the column was stabilized with pedicle screws and metal plates corresponding to T1-T2 and T11-T12.In 2003, she was diagnosed with secondary amenorrhea due to a pituitary adenoma. A transsphenoidal resection of the tumor was attempted in 2005, but bleeding resulted in the operation being unsuccessful.In November 2012, the patient was diagnosed with bacterial meningitis. The cerebrospinal fluid (CSF) showed the following: elevated leukocytes of 290 nucleated cells/l with 80% neutrophils, protein concentration at 0.7 g/liter, and CSF glucose concentration of 1.1 mmol/liter. No bacteria were observed in a concentrated Gram stain of the CSF, but Staphylococcus epidermidis and Staphylococcus warneri were isolated. After susceptibility testing of the two isolates, the patient received a 2-week course of intravenous ceftriaxone (4 g once daily). Twelve days after stopping the ceftriaxone treatment, the symptoms of meningitis returned. The CSF showed elevated leukocytes of 853 nucleated cells/l with 85% neutrophils, protein concentration at 0.6 g/liter, and CSF glucose concentration of 0.6 mmol/liter. Again, no bacteria were observed in a concentrated Gram stain, but S. epidermidis was cultured from the CSF and intravenous ceftriaxone was reinstituted. Initially, the clinical response was satisfactory; however, the symptoms recurred in January 2013. Following this recurrence, the decision was made to switch the treatment plan to intravenous meropenem (2 g three times a day) and intravenous vancomycin (1 g twice daily). Treatment with intravenous meropenem and vancomycin continued until the removal of the shunt system in February 2013. It should be noted that the peritoneal part of the shunt system could not be removed. The remaining part had no interaction with the central nervous system. Two weeks after surgical removal of the shunt, the patient was admitted to the Department of Infectious Diseases with a headache, stiff neck, and confusion. The CSF showed the following: elevated leukocytes of 335 nucleated cells/l with 70% neutrophils, protein concentration of 1.2 g/liter, and CSF glucose concentration of 0.6 mmol/liter. Treatment with intravenous meropenem (2 g three times a day) and vancomycin (1 g twice daily) was initiated, and temporary external lumbar drainage was performed. A magnetic resonance imaging scan showed a cranionasal fistula at the point of the previous transsphenoidal resection from 2005. Subsequently, a brain computed tomography showed two osseous defects in the sphenoid sinus. Blood cultures taken ...

Biofilms on Hospital Shower Hoses: Characterization and Implications for Nosocomial Infections

“…Since these reports are based on nonsequencing methods (e.g., pulsed-field gel electrophoresis and blood cultures), it was not possible to perform a more detailed comparison to the isolates and populations recovered in the present study. 16S rRNA gene sequence analysis showed that the closest relative for several of our isolates was Sphingomonas koreensis (99% nucleotide identity), which has been identified as the causative agent of meningitis in at least one previous study (70). Taken together, it is likely that the Sphingomonas isolates recovered here represent opportunistic pathogens.…”

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“…Sphingomonas koreensis represents a human pathogen (Marbjerg et al . ), but information about the pathogenicity of other species of this genus is still lacking. Salmonella enterica , a food‐borne pathogen associated with pork products, was isolated from one enlarged ICLN.…”

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