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Chryseobacterium meningosepticum : a case study


By: Vanessa Ramuth , Dip MLT
Microbiology department,

Central Laboratory ,

Mauritius.
Email: hybrid2002@servihoo.com



Chryseobacterium meningosepticum (C. meningosepticum), formerly known as
Flavobacterium meningosepticum, is a Gram-negative rod widely distributed in nature. It causes meningitis in premature and newborn infants as well as in
immuno-compromised patients ( Chiu et al,2000).


Adult infections are usually acquired nosocomially. C. meningosepticum has been
found in hospital environment  and  have even survived in water supplies following chlorination procedures. Saline solution used for flushing procedures, respiratory equipment and sink drains as well as antiseptic solutions have been reported as sources as Chryseobacterium sp. The most common site of infection is the respiratory tract followed by bacteraemia .

 

We are presenting a case study of a 9 year old male baby admitted at Jawaharlall Nehru hospital on 25th November 2002 with high fever and was suspected to be suffering from meningitis.

His cerebrospinal fluid was sent to the Microbiology Department, for further investigation.

 

Biochemistry of sample:

 

The specimen received was blood stained . A direct microscopy of the cerebrospinal fluid (c.s.f) demonstrated the presence of red blood cells  graded as +++ and few leucocytes. On centrifugation , the supernatant was found to xanthochromic(pale yellow colour). Unfortunately, a cell count could not be performed due to scarcity of fluid received. The c.s.f protein was 585 mg / 100 ml  which is approximately  5 times higher than in a normal neonate. Glucose content was lower than normal (0 .7 mmol/L).

 

Microbiology investigation:

 

Gram stain showed  few pus cells ( white cells) and filamentous Gram- negative bacilli ( +) were also observed.


C.S.F  was cultured on Blood agar, Cystein lactose electrolyte deficient agar (C.L.E.D), Chocolate and Neomycin Blood agar. One drop (50l) of specimen was inoculated in glucose broth enrichment medium. A direct antimicrobial sensitivity testing was also done on Mueller Hinton agar.



 

 

 

The following day , a non lactose fermenter was isolated which was oxidase positive The colony had a pale yellow pigment.(both on blood agar and CLED
The sensitivity pattern was as follows:

Resistance to : Ampicillin , Tetracycline,Co-Trimoxazole Cephalexin, Augmentin, Gentamicin, Cefotaxime,Colistin, Amikacin, Ceftazidine, Ciprofloxacin, Ceftriaxone,
Meropenem.

Sensitivity was only to : Piperacillin and Tazocin.


Such a pattern of Gram-negative bacilli showing resistance to Colistin and being  oxidase positive hints towards a probability of either Burkholderia cepacia or
Chryseobacterium meningosepticum. This was confirmed by doing further sensitivity
testing. Sensitivity to Vancomycin and Rifampicin was noted and this is a characteristic feature of Chryseobacterium meningosepticum. An API 20 NE was used for confirmation:


Conclusion

We would like to confirm isolation of C. meningosepticum is seldom seen in c.s.f sample. With the nature of the sample along with the antimicrobial sensitivity pattern of the organism, accurate and rapid diagnosis is paramount. The species is usually resistant to a range of antibiotics especially those prescribed for Gram-negative bacterial infections.(C.meningosepticum is  sensitive to antibiotics used for Gram- positive organisms)

 

Positive identification of the organism enables prompt treatment and increases the chances of recovery. In this particular case the child was put on  Vancomycin therapy and followed a quick recovery.

References
Chiu CH, Waddingdon M, Greenberg D, Schreckenberger PC, Carnahan AM. (2000) Atypical Chryseobacterium meningosepticum and meningitis and sepsis in newborns and the immunocompromised, Taiwan. Emerg Infect Dis.6(5) p481-6

 

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