
Brevundimonas diminuta Infection in a Congenital Atrial Septal Defect Patient: A Case Report
Correspondence Address :
Dr. Rajkumar Marimuthu,
Postgraduate Student, Department of Microbiology, SRM University, Kattankulathur, Chennai-603203, Tamil Nadu, India.
E-mail: m.raj2426@gmail.com
Brevundimonas species are aerobic, non fermenting Gram negative bacilli. Brevundimonas diminuta (B. diminuta) is not believed to be a significant pathogen, and its virulence is generally low, being rarely isolated from clinical samples. Only a few clinical cases of serious opportunistic infections, particularly in patients with compromised immunity, have been reported for B. diminuta. All known species of Brevundimonas spp. show strong resistance to most antibiotics, according to the Centers for Disease Control and Prevention (CDC). Here, a case of B. diminuta infection in an eight-year-old female child is described. The patient also had a minor Patent Ductus Arteriosus (PDA) and a known congenital Atrial Septal Defect (ASD). Following isolation from the blood sample, the VITEK 2 compact system identified B. diminuta.
Gram negative, Non fermentor, VITEK-2 compactz
An eight-year-old girl presented to the casualty department at night with complaints of fever, cough, and cold for six days. The fever was not associated with any rashes, vomiting, loose stools, or burning micturition. The child had a past history of a similar illness six years before, for which she was admitted and treated. The birth history indicated a normal vaginal delivery, with a weight of 2 kg, immediate crying after birth, and no Neonate Intensive Care Unit (NICU) admission. The child also had a past history of ASD. Significant points in the antenatal history included the mother being a known case of Gestational Diabetes Mellitus (GDM) and receiving treatment. The child attained the milestones for her age and had completed all vaccinations to date.
During the general examination, the child was febrile (100.5°C), alert, and active, with a pulse rate of 108/minute, Oxygen Saturation (SpO2) of 98%, and a respiratory rate of 20/min. Systemic examination revealed a murmur in the Cardiovascular System (CVS), no focal neurological deficits in the Central Nervous System (CNS), bilateral air entry in the Respiratory System (RS), and a soft, non tender abdomen. The diagnosis of acute febrile illness with suspected enteric fever was made, and all routine investigations (Table/Fig 1) were sent along with a blood culture before starting antibiotics. These tests were conducted only before the administration of cefotaxime. The child was then treated with Inj. ceftriaxone i.v. BD, paracetamol 650 mg SOS, i.v. fluids at 30 mL/hr, and Inj. pantaprazole 40 mg i.v. OD for five days. On the fifth day of admission, the blood culture report showed B. diminuta. Hence, the antibiotic treatment was changed to tablet cefotaxime, which resulted in an improvement in the child’s clinical status. Subsequently, the child was discharged after seven days of admission.
Microbiological profile: Non-haemolytic grey colonies were observed on blood agar (Table/Fig 2), grey colonies were seen on chocolate agar (Table/Fig 3), and no growth was detected on the MacConkey agar plate. The microbe was identified as a motile, non lactose fermenting, gram negative, indole-negative, oxidase- and catalase-positive bacillus. The identification of B. diminuta was done with 97% probability and an analysis time of eight hours using the Vitek 2 compact system, based on the examined biochemical traits. The organism was found to be susceptible to other medications tested using the Kirby Bauer disk diffusion method, including amoxicillin-clavulanate, piperacillin tazobactam, imipenem, meropenem, amikacin, and gentamicin, ceftazidime-clavulanate, ceftazidime, cefepime, and cotrimoxazole, but resistant to cefazolin and colistin. After five days of admission, the medication was changed to cefotaxime BD based on antibiotic susceptibility testing (Table/Fig 4). The patient’s hospital stay was uneventful, and she was subsequently discharged in stable condition after seven days. No further follow-up was conducted after discharge.
Brevundimonas is an aerobic, non sporulating, glucose non fermenting, oxidase-positive Gram negative Bacillus (1). It forms orange-pigmented colonies on blood and chocolate agar within 48 hours. Most strains fail to grow on MacConkey agar, as observed in this case. These bacteria are ubiquitous in the environment and have also been isolated in clinical settings. The factors predisposing patients to this infection remain unknown. In this case, it grew in the blood culture and is possibly the first reported case in a patient with congenital ASD/small PDA. There is no relation between Brevundimonas infection and Congenital ASD/small PDA; it is just an incidental finding.
This organism is intrinsically resistant to colistin. Another noticeable feature of this organism is its frequent resistance to fluoroquinolones, and other study data suggest that treatment of future B. diminuta infections with a quinolone should be avoided. Poor choices for treatment include ampicillin, trimethoprim/sulfamethoxazole, and third- and fourth-generation cephalosporins, to which B. diminuta is frequently resistant (2). However, this case differs in the fact that it was found to be sensitive to fluoroquinolones. Susceptibility to other antibiotics, such as aminoglycosides, carbapenems (mostly imipenem), and piperacillin/tazobactam, is more uniform. Piperacillin-tazobactam and amikacin show good susceptibility profiles, and doripenem and tigecycline appear to be promising agents for the treatment of bacteraemia (3). Adequate antimicrobial agents are still warranted in most patients with infections due to Brevundimonas species. Brevundimonas human infections are generally caused by B. diminuta, with only a few cases of severe opportunistic infections reported, particularly in immunocompromised patients, mainly in cases of cancer, cystic fibrosis, and those with indwelling vascular catheters (Table/Fig 5) (4),(5),(6),(7),(8). Reviewing the case reports of B. diminuta, its virulence appears to be low. However, active treatment is necessary (9).
This case report concludes that B. diminuta grew in the blood culture and is possibly the first reported case in a patient with congenital ASD/small PDA. It is also noted that this organism is usually resistant to fluoroquinolones, but in the present case, it was sensitive. Although Brevundimonas spp. are not currently considered major pathogens, it is important that they be re-evaluated. These species have the ability to pass through sterilising filters, allowing them to potentially cause harmful infections with a risk of mortality in some cases. This organism has a low virulence rate and does not pose as big a risk as other non fermenting Gram negative bacteria, such as Burkholderia, etc. However, it is important to consider it as a possible cause of nosocomial infections and to include it in hospital screening and prevention programs. These programs should investigate possible Brevundimonas species outbreaks if these bacteria are clinically isolated in more than one patient.
DOI: 10.7860/JCDR/2024/67427.19401
Date of Submission: Sep 07, 2023
Date of Peer Review: Oct 24, 2023
Date of Acceptance: Mar 20, 2024
Date of Publishing: May 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 11, 2023
• Manual Googling: Mar 15, 2024
• iThenticate Software: Mar 18, 2024 (18%)
ETYMOLOGY: Author Origin
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