Two Novel Clinical Presentations of Burkholderia cepacia Infection

Abstract

We report two cases of multidrug-resistant Burkholderia cepacia (B. cepacia genomovar I) and Burkholderia multivorans causing multiple liver abscesses in a patient with bronchial asthma (case 1) and peritonitis in a patient with cirrhosis and hepatitis C virus disease (case 2), respectively. Both patients were treated successfully. CASE REPORTS Case 1.A 56-year-old man was admitted in the gastrosurgery department with a high-grade fever with chills and hiccoughs for 8 days. He was a cigarette smoker and had chronic obstructive pulmonary disease (COPD) and had been using a nebulizer for asthmatic attacks constantly for the past 4 years. He was conscious, oriented, febrile, anicteric, and pale with mildly tender hepatomegaly. Ultrasonography showed multiple echodense lesions suggestive of liver abscesses. The ultrasoundguided aspiration revealed thick brownish pus containing many polymorphonuclear leukocytes (10 to 15 polymorphonuclear leukocytes per oil immersion field) and gram-negative bacilli, both intra-and extracellularly. The specimen was negative for Entamoeba histolytica and Echinococcus granulosus. Culture grew non-lactose-fermenting, mucoid, smooth colonies with a diameter of approximately 2 mm. The colonies were made up of gram-negative rods. The gram-negative rods were motile, catalase and oxidase positive, and nitrate reduction test positive. The rods oxidized glucose, lactose, mannitol, and maltose. The rods were lysine decarboxylation positive, arginine hydrolysis negative, and resistant to polymyxin B. The polymyxin B-resistant organism was identified as Burkholderia cepacia by the API 20NE (Bio-Mérieux, Marcy l'Etoile, France) and RapID NF Plus systems (Innovative Diagnostics). The kits have accuracy of 70 to 95%, and the RapID NF Plus system is more sensitive for B. cepacia than API 20NE (5). The isolate was later confirmed to be B. cepacia genomovar I by the reference laboratory (SRL Ranbaxy Ltd., Mumbai, India) by molecular typing, using restriction fragment length polymorphism-mediated analysis of the 16S ribosomal DNA locus and DNA amplification fingerprinting. We have performed surveillance for the probable source of infection and to determine whether it was a hospital contaminant. The betadine (10% povidone iodine) used as a skin disinfectant, needle, cotton pack, instrument tray used during the ultrasound-guided aspiration procedure, swabs from bed linen and other materials in the patient's cubicle, and skin swabs from the patient were subjected to culture and found sterile.The sensitivity of B. cepacia isolated from the liver pus sample was tested by broth microdilution according to the 2001 National Committee for Clinical Laboratory Standards (NCCLS) guidelines for aerobically growing bacteria (control strains were Pseudomonas aeruginosa ATCC 27853 and Escherichia coli ATCC 35218 for ␤-lactam/␤-lactamase inhibitor combinations) using cation-adjusted Mueller-Hinton broth (9). In vitro, the organism was sensitive only to ciprofloxacin (1 g/ml) and meropenem (1 g/ml). The patient was given...

Microbiological assessment ofBurkholderia cepaciacomplex (Bcc) isolates in Alexandria Main University Hospital

“…7,21 They all agreed that this organism was highly resistant to multiple antibiotics. Gautam et al 7 in 2009 tested 30 isolated strains of Bcc and they found that their isolates were susceptible to piperacillin-tazobactam ( The three studies agree that resistance to co-trimoxazole is common, only 23.8% of Gautam et al strains and 43.6% of Disbay et al strains were sensitive to it.…”

“…This also explains the lack of reports about the prevalence of B. cepacia infections in Egypt and many countries. [7][8][9] In routine clinical laboratories, the identification of putative Bcc isolates is generally performed using a combination of selective media, conventional biochemical analysis and/or commercial systems. Several different media have been developed for the selective isolation of Bcc isolates from different specimens 10-12 such as B. cepacia selective agar (BCSA), Pseudomonas cepacia (PC) agar, or oxidation-fermentation polymyxin-bacitracin-lactose (OFPBL) agar.…”

First Isolation of Burkholderia cepacia from a Deep Neck Abscess in a Diabetic Patient Successfully Treated with Hyperbaric Oxygen

“…We read with interest the paper by Mukhopadhyay et al describing two novel clinical presentations of Burkholderia cepacia infection (4). We report here the isolation of B. cepacia from patient with a deep neck abscess complicated by mediastinitis.…”

A rare case of community acquired Burkholderia cepacia infection presenting as pyopneumothorax in an immunocompetent individual

“…There are a few case reports of nosocomial infection in India especially in ICU settings [24,25] . However, to the best of our knowledge, this is the first report of B. cepacia isolation in a case of pyopneumothorax in an immunocompetent person in India.…”