bChryseobacterium indologenes is an environmental organism which is usually an opportunistic pathogen, most usually associated with nosocomial or device-related infections. This case, affecting a fit and well adventure traveler, demonstrates that it may be an agent of severe sepsis in otherwise healthy humans.
CASE REPORTA 53-year-old man with no underlying medical conditions was admitted with septic shock 1 week after returning from hiking the Kokoda Track in Papua New Guinea. He presented with a 2-day history of dysuria and 1 day of prostration, fever, and rigors. He had initially become unwell 13 days prior to presentation, while hiking. He developed copious, frequent, watery diarrhea, vomiting, and malaise, for which he initiated treatment with norfloxacin at 400 mg twice daily for 7 days. The diarrhea resolved after 2 days, and he was able to continue hiking and complete the trek. He had no urinary symptoms at this time. He returned to his home city and returned to work. Four days after ceasing norfloxacin treatment, he developed urinary frequency. He became progressively more unwell and presented to his general practitioner, who referred him to a hospital the following evening. On presentation, he was in vasodilatory septic shock, febrile, and confused. His temperature was 41.5°C (106.7°F), his heart rate was 145 beats per minute, his respiratory rate was 24 breaths per minute, and his blood pressure was 89/55 mm Hg. He had ongoing urinary symptoms and was referred to the urology team for admission. He had no renal angle tenderness or prostatic tenderness on examination. His creatinine level was 1.69 mg/dl, he had a neutrophilic leukocytosis, and his venous lactate level was 5.1 mmol/liter. A computed tomography scan of the abdomen revealed presacral thickening and perirectal stranding consistent with proctitis. He was resuscitated with intravenous fluids in the emergency department, and persistent hypotension prompted transfer to the intensive care unit for vasopressor therapy. He was treated with ciprofloxacin and gentamicin for sepsis, presumably of urinary tract origin.Cultures of urine and blood collected at the time of admission yielded a pure growth of bright yellow-pigmented colonies on 5% horse blood agar incubated in 5% CO 2 for 24 h. No other pathogens were detected on cultures or blood film, and stool microscopy revealed no inflammatory cells or parasites. Gram stain of the colonies showed Gram-negative rods. The organism was oxidase positive and spot indole positive and was tested and identified as Chryseobacterium indologenes by Vitek2 (bioMérieux) and API 20 NE (bioMérieux; biotype profile number 2610004, 99.5% probability, T 0.94). This was confirmed by partial 16S rRNA PCR, sequencing, and matching of the 427-bp fragment with BLASTN to sequences available in the GenBank database, with 100% query coverage and a 99% match, according to CLSI guidelines (1). Antibiotic susceptibility testing performed using automated broth microdilution and CLSI interpretive criteria for nonfermentative Gram-n...