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  Table of Contents    
CASE REPORT  
Year : 2016  |  Volume : 59  |  Issue : 1  |  Page : 119-121
Sphingomonas paucimobilis septicemia in a neonate: A rare case report


1 Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India
2 Department of Surgery, Subharti Medical College, Meerut, Uttar Pradesh, India

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Date of Web Publication9-Mar-2016
 

   Abstract 

Sphingomonas paucimobilis , a yellow-pigmented, aerobic, glucose nonfermenting, Gram-negative bacilli is a rare cause of human infection. It was first discovered as an infective agent in humans in 1977 and named Pseudomonas paucimobilis. It was renamed as S. paucimobilis in 1990 in accordance with phylogenetic data. S. paucimobilis is an aerobic bacterium found in soil and water; it is a rare cause of healthcare associated infections. S. paucimobilis can cause infections in healthy as well as immunocompromised individuals. At first, its colony looks like Gram-positive bacilli colony, so by mistake it is discarded as contaminants. S. paucimobilis is an emerging pathogen and it should not be discarded as contaminants. Here, we report a case of S. paucimobilis bacteremia in a neonate who presented with respiratory distress.

Keywords: Interleukin-6, neonatal septicemia, Sphingomonas paucimobilis

How to cite this article:
Chowdhary P, Ranjan R, Pandey A, Kumar R. Sphingomonas paucimobilis septicemia in a neonate: A rare case report. Indian J Pathol Microbiol 2016;59:119-21

How to cite this URL:
Chowdhary P, Ranjan R, Pandey A, Kumar R. Sphingomonas paucimobilis septicemia in a neonate: A rare case report. Indian J Pathol Microbiol [serial online] 2016 [cited 2019 Nov 12];59:119-21. Available from: http://www.ijpmonline.org/text.asp?2016/59/1/119/174821



   Introduction Top


Sphingomonas paucimobilis is an aerobic bacterium found in environment. It was first discovered as an infective agent in humans in 1977 and named Pseudomonas paucimobilis. It was renamed as S. paucimobilis in 1990 in accordance with phylogenetic data. [1],[2] S. paucimobilis is a rare cause of healthcare associated infections. [3],[4] The route of infection can be endogenous from previous colonization of the patient or exogenous via the implantation of various indwelling devices or via contaminated fluids in the hospital. The present case report describes the clinical characteristics and manifestations of S. paucimobilis bacteremia in a neonate. In our knowledge, this is the first case of neonatal sepsis due to S. paucimobilis reported from North India.


   Case report Top


A 1-day-old male baby having weight 2.9 kg with respiratory distress was brought to pediatric outpatient clinic in our hospital in September 2013. The baby was gasping after birth. He was full term baby born by vaginal delivery. Baby did not cry immediately after birth.

The mother complained of leaking per vaginum for 4 h before delivery. The liquor was meconium stained and there was history of mouth to mouth breathing given to the baby. The patient was admitted and intubated, intravenous fluids were given and injection cefotaxime and amikacin was started. The investigations showed C-reactive protein (CRP) negative on 1 st day. However, CRP was positive (41.70 g/l) by nephalometry on 3 rd day of admission. The interleukin-6 value on the day of admission was 250 pg/ml. Two sets of blood culture were taken and both yielded yellow-pigmented, wrinkled, nonlactose fermenting colony [Figure 1] and [Figure 2]. Gram stain showed Gram-negative bacilli. The microorganism was positive for motility test, oxidase test, citrate utilization, esculin hydrolysis and negative for urease test, nitrate reduction test and glucose fermentation. The isolate was identified as S. paucimobilis by Vitek 2 system (bioMerieux, USA). Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method and the isolate was resistant to aztreonam, cefoperazone- sulbactam, piperacillin and sensitive to cefepime, meropenem, ciprofloxacin, piperacillin-tazobactam, gentamycin, imipenem, and levofloxacin. His hemoglobin was 20.6 g/l, total leukocyte count was 30,000/mm 3, neutrophils were 70%, lymphocytes were 23%, monocytes were 06%, and eosinophils were 01%. Platelet count was 179 10 9 /l. Serum electrolytes were sodium 135 meq/l, potassium 6.4 meq/l, and calcium 9.4 meq/l. Value of prothrombin time was 29.2 with INR 2.2 and activated partial thromboplastin time was 25.2.
Figure 1: Growth of Sphingomonas paucimobilis on blood agar

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Figure 2: Growth of Sphingomonas paucimobilis on MacConkey agar

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On the 2 nd day of examination, blood stained gastric aspirate (5-6 ml) was seen. The chest was seen to be hyper inflated. Baby was not maintaining oxygen saturation despite ventilator support. Furthermore, there was increased secretion through endotrocheal tube. Baby was given fresh frozen plasma, then bleeding stopped.

As the patient's condition was not improving the antibiotic was changed to piperacillin-tazobactam 150 mg/kg/day intravenously and amikacin 20 mg/kg intravenously. Patient responded well and was discharged after 15 days of treatment.


   Discussion Top


S. paucimobilis is a yellow-pigmented, aerobic, glucose nonfermenting, Gram-negative bacilli that is widely distributed in the natural environment. [5] The origin of S. paucimobilis nosocomial infections may be endogenous (i.e., they may stem from previous colonization of the patient) or environmental (via the implantation of various indwelling devices) or may be associated with contamination of sterile fluids in hospitals.

S. paucimobilis, a nonfermenting Gram-negative bacillus, is regarded as of minor clinical significance. Not many instances of infections with this organism can be found in the literature. Infections include bacteremia/septicemia caused by contaminated solutions, e.g. distilled water, hemodialysis fluid, and sterile drug solutions.

The organism lacks the lipopolysaccharide components in the outer membrane of the cell wall usually found in the Gram-negative organisms and which are associated with endotoxic activity. [6] The absence of these components may therefore explain the favorable prognosis seen in previously reported cases. S. paucimobilis has been reported to be usually susceptible to tetracyclines, chloramphenicol, trimethoprim/sulfamethoxazole, carbapenems, and aminoglycosides. Its susceptibility to other antimicrobial agents including third-generation cephalosporins and fluoroquinolones is variable. In addition, the organism is usually resistant to penicillins and to first-generation cephalosporins. [3],[5],[7] The published results of susceptibility tests suggest that imipenem alone or an aminoglycoside plus a third-generation cephalosporin should be the agents of choice in the treatment of these infections. [3]


   Conclusion Top


S. paucimobilis can cause infections in healthy as well as immunocompromised individuals. At first, its colony looks like Gram-positive bacilli colony, so by mistake it is discarded as contaminants. S. paucimobilis is an emerging pathogen and it should not be discarded as contaminants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Seo SW, Chung IY, Kim E, Park JM. A case of postoperative Sphingomonas paucimobilis endophthalmitis after cataract extraction. Korean J Ophthalmol 2008;22:63-5.  Back to cited text no. 1
    
2.
Dervisoglu E, Meric M, Kalender B, Sengul E. Sphingomonas paucimobilis peritonitis: A case report and literature review. Perit Dial Int 2008;28:547-50.  Back to cited text no. 2
    
3.
Hsueh PR, Teng LJ, Yang PC, Chen YC, Pan HJ, Ho SW, et al. Nosocomial infections caused by Sphingomonas paucimobilis: Clinical features and microbiological characteristics. Clin Infect Dis 1998;26:676-81.  Back to cited text no. 3
    
4.
Adams WE, Habib M, Berrington A, Koerner R, Steel DH. Postoperative endophthalmitis caused by Sphingomonas paucimobilis. J Cataract Refract Surg 2006;32:1238-40.  Back to cited text no. 4
    
5.
Smalley DL, Hansen VR, Baselski VS. Susceptibility of Pseudomonas paucimobilis to 24 antimicrobial agents. Antimicrob Agents Chemother 1983;23:161-2.  Back to cited text no. 5
    
6.
Kawasaki S, Moriguchi R, Sekiya K, Nakai T, Ono E, Kume K, et al. The cell envelope structure of the lipopolysaccharide-lacking gram-negative bacterium Sphingomonas paucimobilis. J Bacteriol 1994;176:284-90.  Back to cited text no. 6
    
7.
Reina J, Bassa A, Llompart I, Portela D, Borrell N. Infections with Pseudomonas paucimobilis: Report of four cases and review. Rev Infect Dis 1991;13:1072-6.  Back to cited text no. 7
    

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Correspondence Address:
Ritesh Ranjan
Department of Surgery, Subharti Medical College, Meerut, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.174821

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