Persistent Infection Because of Pandoraea sputorum in a Young Cystic Fibrosis Patient Resistant to Antimicrobial Treatment

Abstract

We report the case of a 13-year-old boy with cystic fibrosis with a pulmonary exacerbation concomitant to the first isolation of Pandoraea sputorum. The imipenem and trimethoprim-sulfamethoxazole treatments failed, with persistence of the bacteria, bronchial congestion and a decline in lung function. Pandoraea sp. is rarely isolated, with only 10 cases reported in France in 2011.

First time identification of Pandoraea sputorum from a patient with cystic fibrosis in Argentina: a case report

“…These bacteria have been occasionally recovered from the lung transplant and/or respiratory tract of CF patients, as well as from blood cultures in non-CF patients and environmental samples [ 2 , 4 , 8 , 19 ]. In our review of the bibliography, we found few cases of CF patients chronically colonized with P. sputorum : one case from Australia [ 8 ], two cases from Spain [ 10 , 11 ], and one case from France [ 5 ]. Interestingly, in our CF patient, S. aureus and P. aeruginosa were eventually isolated from respiratory tract cultures together with P. sputorum .…”

“…Some of these species have been associated with poor outcomes in CF, and the role that others may play in disease progression remains uncertain [ 2 ]. Bacteria from the Pandoraea genus ( P. pulmonicula , P. pnomenusa , P. apista , P. norimbergensis and P. sputorum ) are NFGNB that are being considered as emerging multi-drug resistant pathogens in the context of CF [ 4 , 5 ]. As they are still poorly known, particularly in terms of mechanisms of natural or acquired resistance and of their impact on lung function and the prognosis of the disease [ 5 ], more information is needed it to evaluate their pathogenic role.…”

“…Bacteria from the Pandoraea genus ( P. pulmonicula , P. pnomenusa , P. apista , P. norimbergensis and P. sputorum ) are NFGNB that are being considered as emerging multi-drug resistant pathogens in the context of CF [ 4 , 5 ]. As they are still poorly known, particularly in terms of mechanisms of natural or acquired resistance and of their impact on lung function and the prognosis of the disease [ 5 ], more information is needed it to evaluate their pathogenic role. Conventional microbiology methods remain problematic for the accurate identification of Pandorea species and misidentification with bacteria of the genus Burkholderia or Ralstonia has been reported [ 6 – 8 ].…”

“…Therefore, descriptions of infections due to Pandoraea species in CF patients could be underestimated. The availability of MALDI-TOF MS in clinical microbiology diagnosis allows a quick and better identification of bacterial species, especially Pandoraea species [ 5 , 8 , 10 – 12 ]. In this study we report for the first time in Argentina, a lung colonization with Pandoraea sputorum , in a young CF patient who did not respond to antibacterial empirical treatment.…”

Highly Diversified Pandoraea pulmonicola Population during Chronic Colonization in Cystic Fibrosis

“…After first colonization, Pandoraea spp. were able to chronically colonize the CF respiratory tract (CFRT) ( Fernández-Olmos et al, 2012 ; Kokcha et al, 2013 ; Pugès et al, 2015 ; Martina et al, 2017 ), were transmissible between patients ( Jørgensen et al, 2003 ; Degand et al, 2015 ) and can produce severe lung diseases and bacteremia ( Pimentel and MacLeod, 2008 ; Kokcha et al, 2013 ). The pathogenicity appears mainly supported by a pro-inflammatory response induction significantly greater than with Pseudomonas aeruginosa ( Caraher et al, 2008 ; Costello et al, 2014 ) and the treatment may be complicated by multidrug resistance conferred by carbapenem-hydrolyzing oxacillinases ( Caraher et al, 2008 ).…”