Elizabethkingia Meningoseptica in a Case of Biliary Tract Infection Following Liver Transplantation

Abstract

Patient: Female, 55Final Diagnosis: Percutaneous transhepatic cholangiography biliary drain infection with Elizabethkingia meningosepticaSymptoms: Right upper quadrant abdominal painMedication: IV Ciprofloxacin 400 mg/12 hrsClinical Procedure: NoneSpecialty: Surgery and Internal MedicineObjective:Rare diseaseBackground:Elizabethkingia meningoseptica (E. meningoseptica) is an aerobic Gram-negative bacillus known to thrive in moist environments, and is now recognized as a hospital-acquired infection, being found to contaminate hospital equipment, respiratory apparatus, hospital solutions, water, and drainage systems. Nosocomial infection with E. meningoseptica occurs in immunocompromised patients, requires specialized identification methods, and is resistant to conventional antibiotics. We report a case of E. meningoseptica infection arising from a percutaneous transhepatic biliary drainage (PTBD) tube.Case Report:A 55-year-old Saudi woman underwent liver transplantation. The post-operative period immediately following transplantation was complicated by anastomotic biliary stricture and bile leak, which was managed with percutaneous transhepatic cholangiography (PTC) with PTBD. She developed right upper quadrant abdominal pain, and her ultrasound (US) showed a sub-diaphragmatic collection. Microbial culture from the PTBD tube was positive for E. meningoseptica, which was treated with intravenous ciprofloxacin and metronidazole. This case is the second identified infection with E. meningoseptica at our specialist center, fifteen years after isolating the first case in a hemodialysis patient. We believe that this is the first case of E. meningoseptica infection to be reported in a liver transplant patient.Conclusions:The emerging nosocomial infectious organism, E. meningoseptica is being seen more often on hospital equipment and medical devices and in water. This case report highlights the need for awareness of this infection in hospitalized immunocompromised patients and the appropriate identification and management of infection with E. meningoseptica.

Elizabethkingia Intra-Abdominal Infection and Related Trimethoprim-Sulfamethoxazole Resistance: A Clinical-Genomic Study

“…A total of eight cases of E. anophelis - or E. meningoseptica -associated intra-abdominal infection were identified with detailed information. With the addition of our case, a total of nine cases are presented in this study [ 6 , 14 , 15 , 16 , 17 , 18 ] ( Table 1 and Table 2 ).…”

“…In addition to indwelling catheter or stent, recent operation or invasive procedure was also a significant risk factor for Elizabethkingia intra-abdominal infection. In our literature review, one patient had recent liver transplantation from a living donor within one month and the other patients had peritonitis just after medication termination of pregnancy [ 14 , 17 ]. The first outbreak in Singapore was noted in a surgical intensive care unit and in a cardiothoracic intensive care unit; three out of five patients were found to have E. anophelis infection after surgery [ 5 ].…”

“…A total of eight cases of E. anophelisor E. meningoseptica-associated intra-abdominal infection were identified with detailed information. With the addition of our case, a total of nine cases are presented in this study [6,[14][15][16][17][18] (Tables 1 and 2). Among the nine cases, there were two infected ascites, three CAPD peritonitis, three hepato-biliary infections, and one peritonitis after gynecologic procedure.…”

A Rare Case of Elizabethkingia meningoseptica Bacteremia After Liver Transplantation

“…E. meningoseptica is a gram-negative bacillus of the genus Chryseobacterium [ 1 ]. Risk factors associated with E. meningoseptica infection include cancer, hypoalbuminemia, diabetes mellitus, central venous catheter, low neutrophil count, corticosteroid use, organ transplantation, and inappropriate use of antibiotics [ 4 – 6 ].…”

A rare case of Elizabethkingia meningoseptica bacteremia followed by meningitis in post‐liver transplant patient

“…2,5 There were few cases reported in liver transplant patients. 1,6 We have a case of E. meningoseptica bacteremia followed by meningitis in a recipient of a liver transplant in a tertiary care hospital in Gujarat, India.…”