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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 29  |  Issue : 3  |  Page : 182-184

Septicaemia due to Ochrobactrum anthropi in a patient with Guillain Barre Syndrome


1 Department of Neuromicrobiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
2 Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India

Date of Web Publication1-Dec-2015

Correspondence Address:
Ravikumar Raju
Department of Neuromicrobiology, Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-4958.170808

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  Abstract 

Ochrobactrum (O.) anthropi is an opportunistic emerging pathogen. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems. We report a case of septicaemia due to O. anthropi in a patient with Guillain Barre Syndrome in a neurology centre. The infection along with microbiological characteristics and clinical significance of the organism is described.

Keywords: Emerging pathogen, Guillain Barre Syndrome, ochrobactrum anthropi, septicaemia


How to cite this article:
Patra N, Raju R, Prakash MR, Mustare VK. Septicaemia due to Ochrobactrum anthropi in a patient with Guillain Barre Syndrome. J Med Soc 2015;29:182-4

How to cite this URL:
Patra N, Raju R, Prakash MR, Mustare VK. Septicaemia due to Ochrobactrum anthropi in a patient with Guillain Barre Syndrome. J Med Soc [serial online] 2015 [cited 2021 Dec 8];29:182-4. Available from: https://www.jmedsoc.org/text.asp?2015/29/3/182/170808


  Introduction Top


O. anthropi is regarded as emerging opportunistic pathogen of low pathogenicity, but severe infections have occurred both in immunocompromised and immunocompetent hosts. Ochrobactrum spp. have been isolated from soil, hospital water sources, antiseptic solutions, contaminated pharmaceuticals, and may also be part of the normal flora of the human large intestine. This organism has been reported as a cause of central venous catheter line infection, [1] pancreatic abscess, [2] puncture wound osteochondritis, [3] endophthalmitis, [4] urinary tract infection [5] and meningitis. [6]

Here we report a case of septicemia due to a rare pathogen O.anthropi in a patient with Guillain Barre Syndrome.


  Case Report Top


A 54 year old male was admitted to our hospital with chief complains of weakness in all limbs. His medical history revealed no predisposing event, such as dental procedures or intravenous injections. He was diagnosed as Guillain Barre Syndrome and as a part of treatment plasmapheresis was started. On the second day, he was intubated due to development of poor cough effort and hypoventilation. On the fourth day, he developed bradycardia (pulse rate 24 beats/minute) and cardiac examination revealed asystole. Following cardio-pulmonary resuscitation the cardiac activity was revived. Echocardiography was suggestive of ischemic heart disease, left ventricle segmental hypokinesia with ejection fraction 58%. On the fifth hospitalization day, he developed fever (101 ° F) with rigor and chills. Lab tests showed haemoglobin concentration of 13.8 gm/dl, platelet count of 2,18,000/μl and leucocyte count of 11000/μl. CSF analysis showed glucose of 73 mg/dl, protein of 45 mg/dl and cell count of two cells/mm 3 which were lymphocytes. Test for Human Immunodeficiency Virus (HIV) was negative.

Urine, tracheal secretion, and blood samples were collected and sent to routine microbiology diagnostic laboratory before starting treatment. Urine and tracheal secretion samples revealed no growth of bacteria. Blood was sent in BacT/ALERT blood culture bottle (BioM΄erieux) and it flashed positive within 24 hours of incubation. The gram stain of broth from the bottle showed gram-negative rods, which was further sub cultured on 5% sheep blood agar and MacConkey's agar media. After 24 hours of aerobic incubation of plates at 37 ° C, the colonies on 5% sheep blood agar were about one mm in diameter, circular, low convex, smooth, shining with entire margin; on MacConkey's agar colonies were mucoid and non-lactose fermenting. On Gram staining, gram- negative bacilli were seen. The organism was motile, oxidase positive, catalase- positive, non-fermenter (alkaline butt and alkaline slant on triple sugar iron (TSI) medium), indole negative, urease positive. It was identified as Ochrobactrum anthropi by Vitek 2C-60 (BioM΄erieux) with 99% probability.

Antibiotic sensitivity was determined by Kirby Bauer's disc diffusion method. The isolate was sensitive to gentamicin (10 μg/disc), amikacin (30 μg/disc), ciprofloxacin (5 μg/disc), imipenem (10 μg/disc), trimethoprim/sulfamethoxazole (1.25/23.75 μg/disc), ofloxacin (5 μg/disc), piperacillin/tazobactam (100/10 μg/disc) and resistant to ampicillin (10 μg/disc), aztreonam (30 μg/disc), piperacillin (30 μg/disc), ceftazidime (30 μg/disc), ceftriaxone (30 μg/disc), cefotaxime (30 μg/disc), chloramphenicol (30 μg/disc). Patient was treated with amikacin (15 mg/kg/day intravenous in three divided doses) and piperacillin + tazobactam (3.375 g intravenous every eight hourly) along with other supportive management. After seven days of treatment patient became afebrile with stable vitals. A fresh blood sample was collected in BacT/ALERT blood culture bottle, which showed no growth of bacteria after seven days of incubation. He was treated thereafter for Guillain Barre Syndrome and ischemic heart disease.


  Discussion Top


Ochrobactrum spp. belongs to the family Brucellaceae and is an aerobic, gram-negative, motile, non-lactose-fermenting, oxidase-producing, and urease-positive bacillus; it was formerly classified as an Achromobacter species or CDC group Vd, but it belongs to the new genus Ochrobactrum. This organism rarely causes human infections but when encountered, it is frequently found to involve contaminated medical materials and devices. The host is frequently immunocompromised, but not always. In this patient, HIV status was negative. He might have acquired the infection from the hospital environment.

Arora et al. 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. [7] Ciesalk et al. reported a case of catheter- associated bacteremia caused by O. anthropi in a three year old girl with retinoblastoma. [1] Yu et al. reported the clinical characteristics of 15 cases of O. anthropi bacteremia [8] and they stated that all patients had severe underlying disease and manifested primary O. anthropi bacteremia without obvious focus; however, none of the patients died directly from the infection. A case of life-threatening septic shock that occurred in an otherwise healthy host after administration of a peripheral venous infusion of a solution contaminated with O. anthropi has also been reported. [9] A nosocomial outbreak involved three cases of O. anthropi meningitis in postoperative pediatric neurosurgical patients and was traced to pericardial patches processed in apparently contaminated aliquots of Hanks' balanced salt solution. [6] Braun et al. had reported O. anthropi as the etiological agent causing endophthalmitis complicating cataract surgery and it was treated by removing the intra ocular lens. [4]

Generally, the organism is considered susceptible to gentamicin, fluoroquinolones, sulfamethoxazole-trimethoprim, and colistin. [4] Arora et al. found the isolate to be sensitive to ciprofloxacin, sulbactam-cefoperazone and imipenem, moderately sensitive to tobramycin and resistant to piperacillin, ticarcillin, cefotaxime, cefoperazone, amikacin, gentamicin and aztreonam. [7] Most O. anthropi isolates have been proven to be widely resistant to chloramphenicol and all β-lactams (except imipenem) via production of the AmpC β-lactamase OCH-1. This β-lactamase is chromosomal, inducible, and resistant to inhibition by clavulanic acid. [1],[10]

O. anthropi has a potential role in causing blood stream infections, especially in seriously ill patients with intravenous devices but also in immunocompetent patients without an evident focus of infection. It is important to create awareness due to serious morbidity associated with disseminated O. anthropi infections and the resistance to many antibiotics. So, effective methods of sterilization and infection control guidelines to be followed to prevent such opportunistic nosocomial pathogens in the hospital environment.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Cieslak TJ, Robb ML, Drabick CJ, Fischer GW. Catheter-associated sepsis caused by Ochrobactrum anthropi: Report of a case and review of related nonfermentative bacteria. Clin Infect Dis 1992;14:902-7.  Back to cited text no. 1
    
2.
Appelbaum PC, Campbell DB. Pancreatic abscess associated with Achromobacter group Vd biovar 1. J Clin Microbiol 1980;12:282-3.  Back to cited text no. 2
[PUBMED]    
3.
Barson WJ, Cromer BA, Marcon MJ. Puncture wound osteochondritis of the foot caused by CDC group Vd. J Clin Microbiol 1987;25:2014-6.  Back to cited text no. 3
    
4.
Braun M, Jonas JB, Schönherr U, Naumann GO. Ochrobactrum anthropi endophthalmitis after uncomplicated cataract surgery. Am J Ophthalmol 1996;122:272-3.  Back to cited text no. 4
    
5.
Van Horn KG, Gedris CA, Ahmed T, Wormser GP. Bacteremia and urinary tract infection associated with CDC group VD biovar 2. J Clin Microbiol 1989;27:201-2.   Back to cited text no. 5
    
6.
Chang HJ, Christenson JC, Pavia AT, Bobrin BD, Bland LA, Carson LA, et al. Ochrobactrum anthropi meningitis in pediatric pericardial allograft transplant recipients. J Infect Dis 1996;173:656-60.  Back to cited text no. 6
    
7.
Arora U, Kaur S, Devi P. Ochrobactrum anthropi septicaemia. Indian J Med Microbiol 2008;26:81-3.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Yu WL, Lin CW, Wang DY. Clinical and microbiologic characteristics of Ochrobactrum anthropic bacteremia. J Formos Med Assoc 1998;97:106-12.  Back to cited text no. 8
    
9.
Kettaneh A, Weill F, 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. 9
    
10.
Nadjar D, Labia R, Cerceau C, Bizet C, Philippon A, Arlet G. Molecular characterization of chromosomal class C beta-lactamase and its regulatory gene in Ochrobactrum anthropi. Antimicrob Agents Chemother 2001;45:2324-30.  Back to cited text no. 10
    



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