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LETTER TO EDITOR  
Year : 2013  |  Volume : 56  |  Issue : 3  |  Page : 317-318
Ochrobactrum anthropi septicemia and pneumonia in a preterm, small for gestational age infant with multiple congenital anomalies


1 Department of Microbiology, Maulana Azad Medical College, New Delhi-110002, India
2 Department of Pediatrics, Maulana Azad Medical College, New Delhi-110002, India

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Date of Web Publication24-Oct-2013
 

How to cite this article:
Kumar S, Kapoor S, Chadha S, Saigal SR. Ochrobactrum anthropi septicemia and pneumonia in a preterm, small for gestational age infant with multiple congenital anomalies . Indian J Pathol Microbiol 2013;56:317-8

How to cite this URL:
Kumar S, Kapoor S, Chadha S, Saigal SR. Ochrobactrum anthropi septicemia and pneumonia in a preterm, small for gestational age infant with multiple congenital anomalies . Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Jun 4];56:317-8. Available from: http://www.ijpmonline.org/text.asp?2013/56/3/317/120411


Sir,

A 45-day-old male presented with cough for 3 days and fast breathing since 2 days to the out-patient department. This had been a preterm (33 weeks), small for gestational age infant born by normal vaginal delivery to a primigravida female through clear liquor in a supervised center. The neonate remained admitted for very low birth weight and respiratory distress at birth for nearly a month. The birth weight was 1.6 kg with length of 42.5 cm and the weight on discharge from the government hospital was 1.57 kg. At presentation, the infant had difficulty in feeding and sleeping and excessive lethargy for 8-10 h before presentation. He had also experienced fast breathing in the form of increased rates and chest retractions. On examination, the infant was sick looking and emaciated. He was febrile with a pulse rate of 160/min and a respiratory rate of 60/min. Bilateral crepts were noted and a pansystolic murmur was present all over the chest. The rest of systemic examination was unremarkable. Laboratory investigations showed hemoglobin 6.4 g/dl, total leukocyte count 14,200/mm 3 , platelet count 2.6 lacs/mm 3 and peripheral smear examination revealed a microcytic hypochromic anemia. The blood urea was 45 mg/dl while the serum creatinine was 0.8 on the day of admission. The child's chest X-ray indicated a left sided opaque hemithorax and a right sided consolidation with the collapse in the upper lobe. Ultrasound of the chest was carried out and revealed minimal pleural effusion with underlying consolidation. Echocardiography revealed a tiny patent ductus arteriosus of 1.5 mm, a left to right shunt with normal biventricular function. The ultrasound of the kidney, ureter and bladder region demonstrated a left multicystic dysplastic kidney. The child was started on ceftriaxone and amikacin in antisepticemic doses as per the unit protocol.

The child's urine and blood were collected aseptically on the day of admission, before starting treatment and were sent to the routine microbiology diagnostic laboratory. No pathogenic bacteria were grown on urine culture. The blood culture bottle was incubated at 37°C aerobically for 24 h and was then sub-cultured on 5% sheep blood agar and MacConkey agar media. After 24 h of aerobic incubation of plates at 37°C i.e., 3 rd day, the colonies on 5% sheep blood agar were about 1 mm in diameter, circular, low convex, smooth, shining with entire edge and on MacConkey agar colonies were mucoid and non-lactose fermenting. On gram staining, medium sized gram-negative rods with no specific arrangement were observed. The organism was motile at room temperature and was catalase, oxidase, urease and citrate positive, indole negative, reduced nitrate to nitrite, utilized glucose, xylose and mannitol oxidatively on Hugh and Leifson's oxidative/fermentative medium, did not hydrolyze esculin and was ortho-nitrophenyl-β-D-galactoside negative. The organism was a non-fermenter (glucose and mannitol sugars negative) and gave an alkaline slant by no change in the butt reaction on triple sugar iron agar. Based on the above biochemical profile the organism was identified as Ochrobactrum anthropi. This finding was further confirmed by the Biomerieux's Vitek 2 Compact system. The organism was sensitive to ciprofloxacin (1 μg/disc), gentamicin (10 μg/disc), imipenem (10 μg/disc), meropenem (10 μg/disc), piperacillin + tazobactam (100/10 μg/disc) and resistant to aztreonam (30 μg/disc) and amikacin (30 μg/disc).

The pediatrician was informed about the blood culture and the antibiotic sensitivity report on the 5 th day following sample submission. The child's fever and respiratory distress had not subsided by this time and chest X-ray showed worsening. Another blood culture sample was then drawn before changing the treatment according to the sensitivity profile of the organism isolated. This sample showed a growth of the same organism with a similar antibiotic sensitivity profile. The child was started on meropenem in appropriate doses. This treatment was continued for 7 days after which the child became afebrile, his respiratory distress improved and he started accepting orally. A fresh blood culture sample was drawn and this showed no growth at 37°C after 5 days of aerobic incubation. He was treated thereafter by a multidisciplinary mode utilizing services of pediatric cardiology, pediatric surgery and genetics.

O. anthropi is an aerobic, non-fastidious, gram-negative, motile, non-fermenting bacillus with strict oxidative metabolism that possesses a very active urease. [1] It is a common soil alphaproteobacterium that colonizes a wide spectrum of organisms and is being increasingly recognized as an opportunistic human pathogen. [2] O. anthropi has been isolated from a number of environmental sources, but is also recovered from clinical specimens, especially blood. It has been associated primarily with bacteremia and sepsis, especially in cases involving infected indwelling catheter lines. [3]

In this case, the bacterium was isolated from a preterm, small for gestational age infant with multiple congenital anomalies (patent ductus arteriosus and left multicystic kidneys). Our findings corroborate with Arora et al. who have reported a case of O. anthropi septicemia in an elderly male patient with coronary artery disease with severe left ventricular dysfunction admitted in the intensive coronary care unit of a hospital in India. [4] However, our findings differ from those of Kettaneh et al. who reported a case of septic shock caused by O. anthropi in an otherwise healthy host from a hospital in France. [1] Potentially life-threatening infections, like endocarditis are also included in the list of reported O. anthropi infections. Stiakaki et al. reported the characteristics of 14 O. anthropi bacteremic episodes in 11 children with Hickman-type central catheters. [5] Children presented with fever and non-specific clinical manifestations. Bacteraemia was successfully treated with antibiotics, but catheter removal was necessary to achieve cure in four cases.

We hereby report a preterm infant with O. anthropi pneumonia with a long neonatal intensive care unit (NICU) stay and emphasize the need for aggressive surveillance and need for good NICU sterilization practices. We also stress the importance of accurate identification of this unconventional pathogen in the microbiology laboratory rather than being regarded as a laboratory contaminant as it can cause clinically significant and sometimes fatal infections especially in immunocompromised individuals.

 
   References Top

1.Kettaneh A, Weill FX, Poilane I, Fain O, Thomas M, Herrmann JL, et al. Septic shock caused by Ochrobactrum anthropi in an otherwise healthy host. J Clin Microbiol 2003;41:1339-41.  Back to cited text no. 1
    
2.Chain PS, Lang DM, Comerci DJ, Malfatti SA, Vergez LM, Shin M, et al. Genome of Ochrobactrum anthropi ATCC 49188 T, a versatile opportunistic pathogen and symbiont of several eukaryotic hosts. J Bacteriol 2011;193:4274-5.  Back to cited text no. 2
    
3.Oliver JW. Ochrobactrum anthropi misidentified as Shewanella putrefaciens. J Clin Microbiol 2003;41:4486.  Back to cited text no. 3
    
4.Arora U, Kaur S, Devi P. Ochrobactrum anthropi septicaemia. Indian J Med Microbiol 2008;26:81-3.  Back to cited text no. 4
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5.Stiakaki E, Galanakis E, Samonis G, Christidou A, Maraka S, Tselentis Y, et al. Ochrobactrum anthropi bacteremia in pediatric oncology patients. Pediatr Infect Dis J 2002;21:72-4.  Back to cited text no. 5
    

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Correspondence Address:
Surinder Kumar
Director Professor, Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.120411

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