Community-acquired BacteremicAchromobacter xylosoxidansType IIIa Pneumonia in a Patient with Idiopathic IgM Deficiency

Abstract

A man was hospitalized with bacteremic Achromobacter xylosoxidans type IIIa pneumonia. The authors are aware of no previously reported similar infections caused by this bacterium. A clinical cure was achieved with a combination of carbenicillin and kanamycin therapy. Microtiter susceptibility testing revealed that carbenicillin was the antibiotic to which A. xylosoxidans IIIa was most sensitive (minimal inhibitory concentration, 1.6 microgram/ml) and that synergy between carbenicillin and kanamycin existed. During the patient's hospitalization, deficiency of IgM (21 mg/dl) was found. Specific serum activity against A. xylosoxidans IIIa was detected by the agglutination method. Specific anti-A. xylosoxidans IIIa IgG, but not IgM, was detected by indirect immunofluorescence. It appears that a defect in immunologic recognition of A. xylosoxidans IIIa as an invasive bacterium, a defect in synthesis of specific IgM, or both, contributed to this patient's infection.

In vitro susceptibility of Alcaligenes denitrificans subsp. xylosoxidans to 24 antimicrobial agents

“…xylosoxidans. Confirming the results of previous reports (2,3,5,6,10,15,20,22,24), all the aminoglycosides (including amikacin) were found to lack activity against A. denitrificans subsp. xylosoxidans.…”

“…xylosoxidans are scarce. The multiresistance pattern of susceptibility of this organism to several antibiotics has been emphasized in previous reports (2,3,5,6,10,15,20,22,24 (20). Reference strain ATCC 27061 was also included in the study.…”

“…However, well-documented infections have been reported on several occasions. These include neonatal meningitis (16), ventriculitis after neurosurgery (22), fatal bacteremia (6,9,14,20), pneumonia (2,5,20,23), urinary tract infections (10), peritonitis (15,20), aortic root graft infection (18), endocarditis (13), and otitis externa (19). Nosocomial outbreaks usually associated with an aqueous source (usually nonbacteriostatic saline or hemodialysis fluid) have also been described (14,20).…”

Achromobacter xylosoxidans Infection Presenting as a Pulmonary Nodule Mimicking Cancer

“…A. xylosoxidans has been isolated in cases of ear and eye infections (26,28,30), urinary tract infections (28,38), intra-abdominal infections (39), liver abscesses (4), soft tissue infections (5, 29), osteomyelitis (42), arthroplasty infections (37), meningitis (8,26,29,30), ventriculitis (35), endocarditis (1, 2, 41), and pneumonia (3, 10-13, 20, 32, 34, 39, 44). A. xylosoxidans has been isolated from multiple sources, including blood (3,9,11,16,18,28,33), cerebrospinal fluid (CSF) (8,26,29,30), stool, urine (28,38), sputum (40), skin, ear discharge (29,45), wounds (29), abscesses (4, 39), bone (42), joints (37), endocardium (1, 2, 41), ascites fluid (39), and corneal scrapings and vitreous humor fluid (14,22,27,31).…”

“…Pulmonary cases of A. xylosoxidans infection have been associated with a myriad of underlying medical problems, including IgM deficiency (11), hematologic malignancies, including acute myelogenous leukemia (AML) (18,34), solid organ malignancies (20,39), COPD (12), and CF (10, 13, 39, 44) ( Table 1). In one study, A. xylosoxidans was the most common Gram-negative nonfermenter in CF patients, second only to Pseudomonas aeruginosa (13).…”