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Year : 2010  |  Volume : 53  |  Issue : 3  |  Page : 568-569
Chryseomonas luteola bacteremia in a patient with left pyocele testis with Fournier's scrotal gangrene


Department of Clinical Microbiology, Apollo Health City, Jubilee Hills, Hyderabad - 500 033, India

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Date of Web Publication22-Oct-2010
 

How to cite this article:
Ramana K V, Kareem M A, Sarada C, Sebastian S, Lebaka R, Ratnamani M S, Rao R. Chryseomonas luteola bacteremia in a patient with left pyocele testis with Fournier's scrotal gangrene. Indian J Pathol Microbiol 2010;53:568-9

How to cite this URL:
Ramana K V, Kareem M A, Sarada C, Sebastian S, Lebaka R, Ratnamani M S, Rao R. Chryseomonas luteola bacteremia in a patient with left pyocele testis with Fournier's scrotal gangrene. Indian J Pathol Microbiol [serial online] 2010 [cited 2021 Aug 1];53:568-9. Available from: https://www.ijpmonline.org/text.asp?2010/53/3/568/68280



   Introduction Top


The nonfermenting bacteria that are similar to Pseudomonas species previously belonged to the Center for Disease Control CDC group Ve. The cellular fatty acid composition of the Ve strains is simila r to that of other Pseudomonas species. The group Ve is divided in to two bio groups by Tatum et al. [1] The bio groups Ve-1 and Ve-2 differ in several phenotypic characters, including the presence of multi-trichous flagella and single polar flagellum in bio groups Ve-1 and Ve-2, respectively. The CDC groups Ve-1 and Ve-2 are named as Chryseomonas luteola and Flavimonas orrhyzihabitans, respectively. The CDC group Ve-1 is placed under the Pseudomonas stutzeri group in compliance with the colony characters as they form dry and wrinkled colonies. Based on the phylogenetic relationship studies, it was found that Chryseomonas luteola and Flavimonas orrhyzihabitans are junior subjective synonyms of Pseudomonas species. [2]

Chryseomonas luteola is an aerobic, Gram-negative, motile rod found in the environment as saprophytes. It was previously named as Pseudomonas luteola and CDC group Ve-1 and was placed under the Pseudomonas stutzeri group based on 16S rRNA analysis. The infections caused by Chryseomonas luteola include bacteremia, pneumonia, biliary tract infections, surgical wound infections, abscesses, peritonitis, subdural empyema and infections associated with the presence of prosthetic devices. We report a case of bacteremia caused by Chryseomonas luteola in a patient with pyocoele testis with Fournier's scrotal gangrene.


   Case Report Top


A 50-year-old man was admitted to the emergency department with complaints of fever and severe pain in the scrotal region. The patient's previous history revealed that 20 days before he had developed high fever and was treated for typhoid in a private clinic. He later noticed severe pain and swelling in the scrotal region. On examination, left scrotal skin necrosis was found. The patient was a chronic smoker and a known hypertensive, having undergone coronary artery bypass graft (CABG) in 2007. There was no history of diabetes, tuberculosis or asthma.

A blood culture was received that grew on blood agar and MacConkey's agar as small round wrinkled colonies with a slight yellow tinge [Figure 1]. On observation, we found that some of the colonies were mucoid or slimy. The isolated bacterium was Gram-negative bacilli, which were slightly curved on Gram's stain [Figure 2]. They were found to be nonfermenters, failing to ferment glucose, lactose, mannitol and other sugars, catalase positive and negative for cytochrome oxidase enzyme. On Triple Sugar Iron Agar medium, H 2 S was not produced. The isolated bacterium was identified by the Micro scan Walk away (Dade Behring Inc., Sacraments, CA, USA) and later confirmed by API 20 E (Biomrieux Inc., Durham, NC, USA). We observed that the yellow pigment had improved with further incubations. The antibiogram of the isolated bacterium was performed by the Kirby-Bauer disk diffusion method. The isolate showed sensitivity to ampicillin, amoxicillin-clavulinic acid, tetracycline, trimethoprim-sulphamethoxazole, gentamicin, amikacin, ceftriaxone, ciprofloxacin, ofloxacin, imipenem, cefoperasone cefotaxime, pipercillin-tazobactum, colistin and tigicycline.
Figure 1: Yellow, pigmented, wrinkled colony of Chryseomonas luteola

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Figure 2: Gram-negati ve bacilli on Gram's stain (Gram's, ×1000)

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Incision drainage and surgical debridement was performed under systemic anesthesia. Subsequently, tissue was received for routine, anaerobic and fungal culture. Anaerobic and fungal cultures yielded no growth but routine culture showed the growth of identical organism having a similar sensitivity pattern. Histopathological studies of the tissue showed fibrosis and sub-acute inflammation with no signs of granuloma, and the tissue was diagnosed as pyocele testes with Fournier's scrotal gangrene. The patient was started on empherical therapy with amoxicillin-clavulinic acid 1.2 mg TID and ciprofloxacin 400 mg TID, to which the patient responded, as revealed by a negative blood culture after 3 days. The patient had an uneventful recovery.


   Discussion Top


Although a saprophyte found in the soil and water, there are several reports of human infections caused by Chryseomonas luteola. The predisposing factors for infection with Chryseomonas luteola include immunosuppressive conditions like use of corticosteroids, previous history of long-term antibiotic therapy, chronic alcoholic abuse with liver cirrhosis, chronic renal failure, malignancy and bone marrow transplant patients. The previous reported cases of infection with Chryseomonas luteola included patients who are immunocompromised due to infection with human immunodeficiency virus (HIV), patients with indwelling intravascular catheters, cancer patients, new born infants and individuals who underwent multiple operations and other debilitating conditions. [3] Infections caused by Chryseomonas luteola included cutaneous infections in both HIV-positive and HIV-negative homosexual men, ascitis in a patient with colonic carcinoma, chronic endophthalmitis in a 61-year-old male, meningitis in a new born presenting with respiratory failure at birth, septicemia in a 13-year-old boy with rheumatic fever and degenerative mitral valve who had undergone heart surgery for valve replacement, endocarditis in a 21-year-old man with ventricular septal defect, infections in neurosurgical patients and a 54-year-old male developing bacteremia with a history of tick bite and as pneumonia in a trauma patient and bacteremia associated with central line infections. [4],[5] Although most of these reports were in individuals with one of the predisposing factors, some case reports also have been documented in otherwise previously healthy individuals. [6] In contrast to the previously reported cases where Chryseomonas luteola showed variable sensitivity to ampicillin, tetracycline and co-trimoxazole, our isolate was found to be sensitive. This suggests that the strain could well have been a community isolate.

All the previously reported cases clearly suggest that Chryseomonas luteola, although a saprophyte, could as well emerge as a potential pathogen. The clinical microbiologists therefore should not ignore them as laboratory contaminants, because reports of infections are on the rise both in immunocompromised and immunocompetent individuals. The bacterium can be seen as a nosocomial pathogen having the ability to cause community-acquired infections.

 
   References Top

1.Tatum HW, Ewing WH, Weaver RE. Miscellaneous gram-negative bacteria. In: Lennette EH, Spaulding EH, Truant JP, editors. Manual of clinical microbiology. 2nd ed. Washington DC: American Society for Microbiology; 1974. p. 270-94.   Back to cited text no. 1      
2.Anzai Y, Kudo Y, Oyaizu H. The phylogeny of the genera Chryseomonas, Flavimonas, and Pseudomonas supports synonymy of these three genera. Int J Syst Bacteriol 1997;47:249-51.   Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Hawkins, R.E., R.A. Moriarty, D.E. Lewis, and E. C. Oldfield. serious infections involving the CDC group Ve bacteria Chryseomonas luteola and Flavimonas oryzihabitans. Rev Infect Dis 1991;13:257-60.  Back to cited text no. 3      
4.Rahav G, Simhon A, Mattan Y, Moses AE, Sacks T. Infections with Chryseomonas luteola (CDC group Ve-1) and Flavimonas oryzihabitans (CDC group Ve-2). Medicine (Baltimore) 1995;74:83-8.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Chihab W, Alaoui A, and Amar M. Chryseomonas luteola identified as the source of serious infections in a Moroccan university hospital. J Clin Microbiol 2004;42:1837-9.  Back to cited text no. 5      
6.Dalamaga M, Karmaniolas K, Chavelas C, Liatis S, Matekovits H, Migdalis I. Pseudomonas luteola cutaneous abscess and bacteremia in a previously healthy man. Scand J Infect Dis 2004;36:495-7.  Back to cited text no. 6  [PUBMED]    

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Correspondence Address:
K V Ramana
Department of Microbiology, Apollo Health City, Jubilee Hills, Hyderabad - 500 033
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.68280

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