Sphingobacterium spiritivorum bacteremia due to cellulitis in an elderly man with chronic obstructive pulmonary disease and congestive heart failure: a case report | Journal of Medical Case Reports


Sphingobacterium species are aerobic, Gram-negative, short rod, non-motile, non-spore-forming bacteria. They are oxidase-positive, catalase-positive, and urease-positive and indole-negative and produce light yellow colonies on blood agar plates [1]. Thus far, more than 20 species in the genus Sphingobacterium have been reported based on 16S ribosomal ribonucleic acid gene sequencing [8] and the number of isolated species is increasing. S. spiritivorum was first isolated from a human clinical specimen by Holmes et al. in 1982 [9] and was initially described as Flavobacterium spiritivorum. In 1983, Yabuuchi et al. first proposed Sphingobacterium as a new genus [10]. The genus Sphingobacterium differs from the genus Flavobacterium by high cellular membrane concentrations of sphingophospholipid and ceramide. Naka et al. performed a structural analysis of sphingophospholipids in S. spiritivorum, thereby purifying a novel sphingolipid among eukaryotic and prokaryotic cells [11].

Sphingobacterium species are ubiquitous and commonly isolated from soil, plants, and water, but rarely from human infection sites. Sphingobacterium multivorum and S. spiritivorum were isolated from very few existing cases. Lambiase et al. reported the isolation of S. multivorum and S. spiritivorum from the sputum of patients with cystic fibrosis [12]. Recently, the first human case of Sphingobacterium hotanense infection in an elderly patient was reported [13]. In that case, scratches on the right arm caused by a rooster were the suspected infection entry site from soil.

Sphingobacterium species are resistant to commonly used antibiotics [1]. S. multivorum can produce an extended-spectrum β-lactamase and a metallo-β-lactamase, which make it resistant to third-generation cephalosporins and carbapenems, respectively [14]. S. spiritivorum is susceptible to carbapenems. Quinolones, trimethoprim-sulfamethoxazole, and ceftazidime are effective in vitro, which is compatible with previous clinical reports [12]. S. spiritivorum isolated from the present case was susceptible to the antibiotics listed above. In the present case, we observed a good clinical course with intravenously administered meropenem followed by orally administered levofloxacin.

We identified five previously reported cases of

S. spiritivorum

infection in the English literature [

2

6

] (Table 

2

). Three cases were caused by cellulitis [

2

,

3

,

6

] and two cases by catheter-related blood stream infection [

4

,

5

]. In most of these cases, the patients had predisposing factors and underlying diseases, such as Parkinson’s disease (with chronic venous stasis due to akinesia and injuries from frequent falls, which are risk factors for cellulitis) [

2

,

3

], refractory anemia [

4

], acute myeloid leukemia treated with chemotherapy [

5

], and end-stage renal disease on hemodialysis [

6

]. One case of extrinsic allergic alveolitis (hypersensitivity pneumonitis) caused by

S. spiritivorum

[

15

] was not included because it was not a direct infection but was caused by a hypersensitivity reaction against organism-derived allergens [

16

]. In our case, edema due to CHF was a risk factor for cellulitis [

17

]. Aging and COPD can also increase susceptibility to infections [

18

,

19

]. Tinea pedis is a risk factor for cellulitis [

20

] because it may provide entry sites for infections [

21

] and changes in bacterial flora [

22

].

Table 2

Previously reported five cases of Sphingobacterium spiritivorum infections and the present case

Case 1 [2]

2002

72/M

Parkinson’s disease

Blood

Cellulitis

Cefazolin followed by ampicillin/sulbactam

Complete recovery

Case 2 [3]

2003

84/M

Refractory anemia

Blood

Cellulitis

Amoxicillin/clavulanate

Complete recovery

Case 3 [4]

2013

68/F

Acute myeloid leukemia treated with chemotherapy

Blood

CRBSI

Cefepime followed by ciprofloxacin

Died

Case 4 [5]

2016

80/F

ESRD on hemodialysis via tunneled central venous dialysis catheter; DM

Blood

CRBSI

Trimethoprim followed by meropenem and ciprofloxacin

Complete recovery

Case 5 [6]

2016

89/M

Parkinson’s disease; skin tears and abrasion due to multiple falls

Blood

Cellulitis

Piperacillin/tazobactam followed by amoxicillin/clavulanate

Complete recovery

The present case

2017

80/M

COPD; edema due to CHF; tinea pedis

Blood

Cellulitis

Meropenem followed by levofloxacin

Complete recovery

Although obtaining blood cultures of patients with cellulitis may not be cost effective, given the low rate of positive blood cultures (2.0%) [23], we could not have made a correct diagnosis in the present case without blood cultures. Mills and Chen reviewed several studies and concluded that obtaining blood cultures does not significantly alter treatment or aid in diagnosing the causative organism in immunocompetent patients with acute cellulitis [24]. In addition, the current Infectious Diseases Society of America (IDSA) guidelines do not recommend routine performance of blood cultures in patients with cellulitis; however, performing blood cultures is recommended in patients with malignancy, chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites [25]. Peralta et al. reported the absence of previous antibiotic treatment and the presence of two or more comorbid factors including obesity, COPD, diabetes, alcohol addiction, liver cirrhosis, CHF, and immunocompromised condition were associated with bacteremia in patients with cellulitis [26]. Lee et al. proposed an initial diagnostic prediction model with four independent predictors for estimating probability of bacteremia in patients with cellulitis: age ≥ 65 years, involvement of non-lower extremities, liver cirrhosis, and systemic inflammatory response syndrome [27]. In a recent study, van Daalen et al. reported the blood culture positivity rate was higher than the rates reported by IDSA guidelines in hospitalized patients with skin and soft tissue infections, particularly in patients with severe comorbidity [28]. Evaluation of patients’ comorbidity is critical to making decisions to perform blood cultures in patients with cellulitis. Considering S. spiritivorum was isolated from blood cultures in all of the previous reports, performing blood cultures in patients with cellulitis with comorbid risk factors can be useful to identify the causative organism and important for appropriate treatment.



Source link

قالب وردپرس



We hope you enjoyed reading the above post. How about helping us share the information to your fans and friends on social media? Meanwhile, you can rely on us daily for the latest and relevant free forex trading signals, free forex trading market news, free forex trading technical levels, weekly Pool draws, latest news from Nigeria and the world, educational articles and quality academic information, insurance news and scientific knowledge.



Do you need a classical ORGANIST or an excellent music teacher? CALL Fabian on 08033983034 or email him at agfab2013@gmail.com


Follow us on twitter @newsbeatportal

learn how to make profit from your losing bets on nairabet, bet9ja, merrybet, surebet. 07030635051
Engage #SantexTech today to build & install inverters, training on inverters & other electronic designs, projects/kits. Call 08039574535


Click to join Talk Nigeria Today, a group where hot, controversial, and breathtaking issues are brainstormed upon.

Konga Verified Blogger

Leave a Reply