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 (50µl) 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