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correspondence

Indian Pediatr 2015;52: 901

Brevundimonas Septicemia: A Rare Infection with Rare Presentation


*Shweta Singh and BD Bhatia

Department of Pediatrics, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India.
Email: [email protected]

 
 


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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