<i>Bordetella holmesii</i>
            Bacteremia in Asplenic Children: Report of Four Cases Initially Misidentified as
            <i>Acinetobacter lwoffii</i>

Panagopoulos, Markos Ioannis; Jean, Maude Saint; Brun, Delphine; Guiso, Nicole; Békal, Sadjia; Ovetchkine, Philippe; Tapiéro, Bruce

doi:10.1128/jcm.00595-10

Cited by 39 publications

(42 citation statements)

References 25 publications

(22 reference statements)

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“…B. holmesii may be an underrecognized pathogen due to its slow growth and difficult identification. There have been reports of repeated misidentifications of this organism as Acinetobacter lwoffii using standard automated laboratory systems; the Vitek2 automated system fails to identify B. holmesii because the microorganism is not included in its database (4). Cellular fatty acid profiles and 16S rRNA gene sequencing are useful for making a definitive identification (3).…”

Section: Discussion B Holmesii Was First Isolated In 1983 and Was Dmentioning

confidence: 99%

Bordetella holmesii, an Emerging Cause of Septic Arthritis

et al. 2013

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f Bordetella holmesii is a well-described pathogen in asplenic and immunocompromised patients. Here we report the first two published cases of septic arthritis caused by B. holmesii documented in apparently immunocompetent patients and unaccompanied by bacteremia. CASE REPORTSC ase 1. A 54-year-old woman presented to the hospital with a suspected right prosthetic knee infection. She had a past medical history significant for hypertension, dyslipidemia, and a bilateral knee replacement in 2008 secondary to osteoarthritis, but no history of frequent or unusual infections. She had experienced chronic pain in her right knee since the initial surgery; because of this, she underwent arthroscopy in July 2010 with a debridement of the meniscus, but the pain did not improve. The pain remained stable until November 2010 when she experienced an acute worsening of her right knee pain associated with swelling, an inability to bear weight, and a low-grade fever. There was no history of corticosteroid injections into the joint for symptom control.On initial examination, the patient had a temperature of 37.9°C and was hemodynamically stable. Her right knee was swollen, tender, and very warm, with a limited range of motion. The remainder of her physical examination was noncontributory.Blood work showed a white blood cell (WBC) count of 9.1 ϫ 10 9 /liter, C-reactive protein (CRP) of 327 mg/liter, and erythrocyte sedimentation rate (ESR) of 90 mm/h. The right knee was aspirated under local anesthesia, and the cell count was 26,060 ϫ 10 6 /liter (94% neutrophils); Gram stain of the aspirate did not show organisms, and bacterial culture was negative after 48 h. There was no growth of any organism in blood culture.The patient was started empirically on intravenous (i.v.) cefazolin and was taken to surgery for a first stage patellofemoral revision with prosthesis removal and replacement by a vancomycin and tobramycin cement spacer.The specimen from the initial knee aspirate was first reported as growing a Gram-negative bacillus after 5 days of culture, after the patient had already undergone surgery. There were four small, gray colonies growing on the blood agar plate incubated aerobically in 5% CO 2 at 35°C. The MacConkey, chocolate agar, and anaerobic plates showed no growth. Gram stain of the culture revealed small Gram-negative bacilli and coccobacilli with much variation in size. Oxidase, urease, and catalase tests were negative. The organism was nonmotile in wet prep and semisolid media incubated at 35°C. There was no growth on a triple sugar iron (TSI) slant. A RapID NH panel (Innovative Diagnostics, Atlanta, GA) was set up but was nonreactive. The patient was switched from cefazolin to ceftriaxone pending identification of the Gramnegative bacterium.The isolate was sent to a reference laboratory but could not be definitively identified by biochemical analysis. Sequencing of a 635-nucleotide region of the 16S rRNA gene was undertaken; this alignment was compared to the NCBI (GenBank plus EMBL plus DDBJ plus PDB sequences) datab...

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Section: Discussion B Holmesii Was First Isolated In 1983 and Was Dmentioning

confidence: 99%

Bordetella holmesii, an Emerging Cause of Septic Arthritis

et al. 2013

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“…It has been predicted that there is a seasonal (autumn-winter) predominance for the illness-onset associated with B. holmesii infections (Shepard et al, 2004). In most reports, species identification by commercial systems failed, and, more recently, a paper reported a systematic misidentification of B. holmesii as Acinetobacter lwoffii using the Vitek2 system (Panagopoulos et al, 2010). The ID 32GN test strip did not allow a reliable identification of B. holmesii since the database of this commercially available diagnostic kit only includes B. bronchiseptica, and does not cover the other species of the genus Bordetella.…”

Section: Discussionmentioning

confidence: 99%

“…B. holmesii was first described in 1995 as a cause of septicaemia in 15 patients (Weyant et al, 1995). Subsequently, B. holmesii has been reported as a cause of bacteraemia, endocarditis and pneumonia, mainly in compromised and, more particularly, in asplenic patients with often anatomical or functional asplenia, such as patients with sickle cell disease (Lindquist et al, 1995;Morris & Myers, 1998;Tang et al, 1998;Njamkepo et al, 2000;Greig et al, 2001;Russell et al, 2001;Shepard et al, 2004;Dörbecker et al, 2007;McCavit et al, 2008;Panagopoulos et al, 2010). The clinical course usually remained uneventful, and patients tended to recover without complications.…”

Section: Discussionmentioning

confidence: 99%

“…B. holmesii is endowed with a factor highly related to filamentous haemagglutinin, a prominent virulence factor of the wellcharacterized pathogenic bordetellae (Link et al, 2007). Whether B. holmesii strains possess a capsule or not is still unknown (Panagopoulos et al, 2010). Regarding host factors, the increased susceptibility to infection and overwhelming sepsis, predominantly with encapsulated bacteria, is well known in asplenic patients.…”

Section: Discussionmentioning

confidence: 99%

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Septic arthritis caused by Bordetella holmesii in an adolescent with chronic haemolytic anaemia

Moissenet

Leverger

Mérens

et al. 2011

Journal of Medical Microbiology

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We describe a case of septic arthritis caused by Bordetella holmesii in a 15-year-old boy with chronic haemolytic anaemia. B. holmesii was identified by 16S rRNA gene sequence analysis. The patient outcome was favourable. To our knowledge, this is the first case of B. holmesii septic arthritis in an asplenic patient. Case reportA 15-year-old male patient with a severe chronic haemolytic anaemia (elliptocytosis) presented to the emergency department of our paediatric hospital (Hôpital ArmandTrousseau) with a fever of 39 u C, a painful left knee lameness and a left thumb oedema since the previous day. Before the boy was 4 years old, an elective splenectomy was first performed in January 1999, and then a total splenectomy in October 2000.At the emergency department (Hôpital Armand-Trousseau), a painful limitation of the knee joint was observed on physical examination, and investigated by aspiration of the knee joint: one aliquot of the aspirate was injected directly into an aerobic broth bottle and analysed using the automated microbial detection system BacT/ALERT (bioMérieux), and additional aliquots were cultured on agar plates (blood agar and chocolate agar) combined with enrichments in two broth bottles (Hemoline; bioMérieux). A blood culture was also performed. The boy was hospitalized, and treated for 24 h with an intravenous antimicrobial combination of cefotaxime (60 mg kg 21 per day) and rifampicin (40 mg kg 21 per day), as well as analgesic drugs. Laboratory findings showed a white blood cell (WBC) count of 23 300 WBCs nl 21 , a C-reactive protein level of 67 mg l 21 and a procalcitonin level of 1.30 ng ml 21 . Afterwards, a left ankle oedema appeared, as well as a generalized jaundice with haemolysis characteristics (haemoglobin58 g dl 21 , reticulocytes5115 000 nl 21 , haptoglobin5low level, and free bilirubin5155 mg l 21 ). A spontaneous decrease of the haemolytic anaemia was subsequently observed. During the hospital stay, on day 1, a synovial biopsy was performed after a surgical knee joint washing, showing a richly vascularized chorion with many neutrophils, and a poor inflammatory response in the aponeurotic tissue resulting in only weakly inflammed tissue. During this operation, two new BacT/ ALERT broth bottles (aerobic/anaerobic) were also directly injected with the joint aspirate specimen. After 24 h, a decrease of the clinical symptoms, such as fever, knee and joint pain, and oedema, was observed, as well as a decrease of the inflammatory syndrome (WBCs513 000 nl 21 , Creactive protein level510 mg l 21 ). The outcome was favourable and the boy was discharged with only an analgesic treatment and the usual penicillin prophylaxis for asplenic patients (2 000 000 IU per day). Microbiological investigationExamination of the synovial fluid showed 10 6 WBCs nl 21 with 80 % neutrophils but no micro-organism observed by Gram-stained smear. The aerobic joint fluid BacT/ALERT bottle set up whilst the patient was in the emergency department grew in 72 h, showing small, coccoid Gramnegative rods. Subcultur...

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“…17 Modes of acquisition also remain to be identified, as no person-to-person transmission has been described. 9 Bordetella holmesii may act as an opportunistic pathogen in particular clinical conditions such as hyposplenism or asplenia, conditions that are also associated with SLE and infections with encapsulated pathogens. 18 While the presence of a polysaccharide capsule in Bordetella holmesii strains remains unknown, other Bordetella spp.…”

mentioning

confidence: 99%