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Indian Pediatr 2015;52: 901 |
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Brevundimonas Septicemia: A Rare Infection
with Rare Presentation
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*Shweta Singh and BD Bhatia
Department of Pediatrics, Heritage Institute of Medical
Sciences, Varanasi, Uttar Pradesh, India.
Email:
[email protected]
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Brevundimonas is a rare bacterium, predominantly causing nosocomial
bacteremia in immunocompromised hosts [1]. Brevundimonas vesicularis
and B. diminuta are the two species isolated in human
infections [1] while third species B. nasdae has not been
isolated from human infection so far [2]. Brevundimonas bacteremia among
children is rare [2]. We report a case of Brevundimonas septicemia
causing bilateral pneumothorax and empyema in an infant.
Eight-month-old infant presented with fever, rapid
breathing and poor oral intake for 5 days. At presentation, infant was
in shock and respiratory distress. Chest auscultation revealed decreased
air entry with hyper-resonant percussion note on left side; Chest X-ray
showed bilateral pneumothorax (tension pneumothorax on left side); chest
tube was inserted in left 7th intercostal space. Collapsed lung expanded
and pus was drained out. Empirically, a combination of ceftriaxone,
amikacin and vancomycin was started. Blood and pus cultures isolated
Brevundimonas vescularis, which was sensitive to quinolones (levofloxacin),
cefoperazone, piperacillin-tazobactum, and amikacin but resistant to
ceftazidime and amoxicillin-clavulanic acid. Cefoperazone and
levofloxacin were added. Chest tube was removed after 5 days and after 2
weeks of treatment, patient was discharged.
Incidence of brevundimonas infection in
immunocompetent host is relatively low [1,3]. Our patient had community
acquired infection while most of the pediatric cases reported so far are
of nosocomial infections. Previous reported infections by this organism
in children are septicemia, pneumonia, meningitis, septic arthritis, and
urinary tract infection [1-4]. In the present case, brevundimonas
bacteremia led to bilateral air leak with empyema. Carbapenem group of
antibiotics including imipenem, meropenem and doripenem are reported to
be effective for these infections [1,2]. The sensitivity pattern for
quinolones is quite variable.
We conclude that community-acquired brevundimonas
septicemia can present as complicated pneumonia with air leak and
empyema.
References
1. Shih TS, Sheng KC, Ming CC, Ning CW, Ya SY, Jung
CL, et al. Brevundimonas vescularis bacteremia resistant to
trimethoprim-sulfamethoxazole and ceftazidime in a tertiary hospital in
southern Taiwan. J Microbiol Immunol Infect. 2012;45:e468-72.
2. Lee MR, Huang YT, Liao CH, Chuang TY, Lin CK, Lee
SW, et al. Bacteremia caused by Brevundimonas species at a
tertiary care hospital in Taiwan, 2000-2010. Eur J Clin Microbiol Infect
Dis. 2011;30:1185-91.
3. Karadag N, Karagol BS, Kundak AA, Dursun A, Okumus
N, Tanir G, et al. Spectrum of Brevundimonas vesicularis
infections in neonatal period: A case series at a tertiary referral
center. Infection. 2012;40:509-15.
4. Gupta PK, Appannanavar SB, Kaur H, Gupta V, Mohan
B, Taneja N. Hospital acquired urinary tract infection by
multidrug-resistant Brevundimonas vesicularis. Indian J Pathol Microbiol.
2014;57:486-8.
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