Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome

Abstract

Patient: Male, 11Final Diagnosis: Chromobacterium violaceum infectionSymptoms: Abscess • fever • rashMedication: —Clinical Procedure: ECMOSpecialty: Critical Care MedicineObjective:Rare diseaseBackground:Chromobacterium violaceum (C. violaceum) is a facultative anaerobic gram-negative bacterium found in soil and water, especially in tropical and subtropical areas. Although infection in humans is rare, it is associated with significant morbidity. The bacterium is known for its resistance to multiple antimicrobials, and the possibility of relapse and reinfection. Presence of bacteremia, disseminated infection, and ineffective antimicrobial agents are predictors of mortality.Case Report:We report the case of a previously healthy 11-year-old male with C. violaceum sepsis who was exposed to stagnant water. He presented with severe septic shock and developed multi-organ system failure. Initial presumptive diagnosis was staphylococcal infection secondary to presence of skin abscesses resulting in antibiotic coverage with vancomycin, clindamycin, nafcillin and ceftriaxone. He also had multiple lung and liver abscesses. Once C. violaceum was identified, he received meropenem and ciprofloxacin, and was later discharged on ertapenem and trimethoprim-sulfamethoxazole (TMP-SMX) to complete a total of six months of antibiotics. He was diagnosed with chronic granulomatous disease (CGD) and is currently on prophylactic TMP-SMX and itraconazole. He has not had any relapses since his initial presentation.Conclusions:This case highlights the importance of considering C. violaceum as a relevant human pathogen, and considering it early in temperate regions, particularly in cases of fulminant sepsis associated with multi-organ abscesses. Once C. violaceum is identified, appropriate antimicrobial therapy should be started promptly, and sufficient duration of treatment is necessary for successful therapy.

Anti-biofilm and Virulence Factor-Reducing Activities of Essential Oils and Oil Components as a Possible Option for Bacterial Infection Control

“…CV is a gram-negative bacterium that occurs in tropical and subtropical areas and lives there in the soil and in stagnant water. In rare cases, the bacterium causes systemic infections in humans, e.g., sepsis [34]. These bacteria are often multiresistant against many known antibiotics and, in addition, they are also good biofilm producers [1,3,34].…”

The Spectrum of Chromobacterium violaceum Infections from a Single Geographic Location

“…2 A total of 154 cases of C. violaceum have been previously published. Location data available for 143 cases reveal a worldwide tropical distribution comprising western Pacific (Vietnam, Japan, Korea, Cambodia, Malaysia, China, Australia, Singapore, Laos, and Papua New Guinea) with 49 cases (34.3%), [3][4][5][6][7][8][9][10][11][12] the Americas with 46 cases (30.0%), 3,13,14 southeast Asia (Thailand, India, Sri Lanka, and Nepal) with 23 cases (16.0%), 3,[15][16][17][18][19][20][21][22] Africa with 22 cases (15.4%), 23,24 Persian Gulf with two cases (1.4%), 25 and Europe with one case (0.7%).…”

Necrotizing Pneumonia Caused by Chromobacterium violaceum: Report of a Rare Human Pathogen Causing Disease in an Immunodeficient Child

“…Reports have also indicated that treatment must be prolonged to prevent relapse of the infection. 13 On the basis of those experiences and out of an abundance of caution, we chose 3 weeks IV followed by 3 months of dual oral medications. The patient tolerated the treatment and remained infection free.…”