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Year : 2011  |  Volume : 54  |  Issue : 4  |  Page : 840-841
Bugs on film: The presence of bacterial rods (Citrobacter koseri) on a routine blood film in a septic immunocompromised patient with a femoral vein line


1 Department of Immunology, PaLMS Immunorheumatology Laboratory, Royal North Shore Hospital; Northern Clinical School, University of Sydney, Sydney, Australia
2 Sydney South Western Area Pathology Service, Liverpool Hospital, Sydney, Australia

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Date of Web Publication6-Jan-2012
 

How to cite this article:
Fernando SL, Lehmann P. Bugs on film: The presence of bacterial rods (Citrobacter koseri) on a routine blood film in a septic immunocompromised patient with a femoral vein line. Indian J Pathol Microbiol 2011;54:840-1

How to cite this URL:
Fernando SL, Lehmann P. Bugs on film: The presence of bacterial rods (Citrobacter koseri) on a routine blood film in a septic immunocompromised patient with a femoral vein line. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Oct 14];54:840-1. Available from: http://www.ijpmonline.org/text.asp?2011/54/4/840/91547


A 47-year-old man required plasmapheresis for severe refractory pemphigus foliaceus during a prolonged hospital admission. He was concurrently receiving immunosuppressive therapy with mycophenolate mofetil 30 mg/kg/daily and prednisone 0.5 mg/kg/daily to prevent rebound synthesis of anti-pemphigus antibodies following completion of plasmapheresis. Access of his subclavian and internal jugular vein was precluded by the presence of confluent ulcerated lesions over his neck and chest [Figure 1]. A femoral vein line was inserted, but after 2 days, he developed septic shock accompanied by disseminated intravascular coagulation. A routine blood film revealed the striking presence of numerous bacterial rods [Figure 2] later identified as Citrobacter koseri on culture. The tip of his femoral line was also cultured and grew C. koseri. The cause of sepsis in this man was initially thought to be a Gram positive coccus secondary to the breached integrity of his skin from pemphigus foliaceus. The identification of bacterial rods on a blood film enabled the early initiation of the broad spectrum antibiotic, meropenem, prior to the growth and identification of C. koseri on culture. The patient recovered following the removal of the femoral line and a course of intravenous antibiotics.
Figure 1: The patient had confl uent, blistering, crusted, and erosive lesions over the face, neck, trunk, and arms. This distribution and the 'corn fl akes' appearance of the lesions are typical of pemphigus foliaceus

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Figure 2: A routine blood fi lm from the septic pa�� ent showing the presence of numerous bacterial rods. (Leishman, ×1000)

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C. koseri is a coliform bacterial species from the Enterobacteriaceae family and is a nosocomial cause of urinary tract, intra-abdominal, skin and soft tissue infections especially in immunocompromised patients. [1] The organism also has a propensity for the neonatal brain causing meningitis, ventriculitis, and cerebral abscesses [2] and animal models suggest that this may be caused by an impaired function of the signalling adaptor protein, MyD88. [3]

This is the first published report of a case of C. koseri infection originating from a femoral vein line. The patient's prolonged hospital stay, immunosuppressive therapy, and site of insertion of his central line were all predisposing factors to infection with this coliform bacterial organism.

 
   References Top

1.Samonis G, Karageorgopoulos DE, Kofteridis DP, Matthaiou DK, Sidiropoulou V, Maraki S, et al. Citrobacter infections in a general hospital: Characteristics and outcomes. Eur J Clin Microbiol Infect Dis 2009;28:61-8.  Back to cited text no. 1
    
2.Martínez-Lage JF, Martínez-Lage Azorín L, Almagro MJ, Bastida ME, Reyes S, Tellez C. Citrobacter koseri meningitis: A neurosurgical condition? Eur J Paediatr Neurol 2010;14:360-3.  Back to cited text no. 2
    
3.Liu S, Kielian T. MyD88 is pivotal for immune recognition of Citrobacter koseri and astrocyte activation during CNS infection. J Neuroinflammation 2011;8:35.  Back to cited text no. 3
    

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Correspondence Address:
Suran L Fernando
Department of Immunology, Royal North Shore Hospital, Reserve Rd, St. Leonards, NSW 2065
Australia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.91547

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