Otomastoiditis caused by Sphingomonas paucimobilis: case report and literature review

Abstract

Sphingomonas paucimobilis is an aerobic Gram-negative bacillus that, although rare in humans, most commonly infects immunocompromised and hospitalized patients. Among the 59 pediatric cases of S. paucimobilis infection reported in the literature, the most common diagnosis involves isolated bacteremia. These cases are related to sporadic or epidemic infections. Death related to this infection occurred in only one case. The authors report a case of an 11-year-old boy with the diagnosis of Sphingomonas paucimobilis otomastoiditis and a thorough review of the literature on this infection in pediatrics. The patient presented a 20-day history of fever, otalgia, otorrhea, and progressive retroauricular swelling with protrusion of the left ear; despite 15 days of amoxicillin regimen. His past medical history included chronic bilateral otitis media, but no cause of immunosuppression was found. A brain computed tomography scan showed left otomastoiditis associated with a large circumscribed fluid collection with deep involvement of the soft tissues of the temporal region, including the subperiosteal space. Blood tests showed neutrophilia and elevated C-reactive protein. Surgical manipulation of the cited collection drained a large amount of a fetid purulent secretion. Ceftazidime and clindamycin were empirically initiated. The outcome was favorable, with fever defervescence and resolution of the scalp deformation. Culture of the drained secretion was positive for S. paucimobilis. Ciprofloxacin was scheduled for a further 10 days after discharge. The follow-up showed complete recovery. As far as we know, this is the first case of S. paucimobilis otomastoiditis, complicated with subperiosteal abscess in an immunocompetent child. The authors call attention to the increasing number of reports on S. paucimobilis infection over the years, and therefore to the importance of this pathogen, which was previously underestimated.

The Gram-Negative Bacilli Isolated from Caves—Sphingomonas paucimobilis and Hafnia alvei and a Review of Their Involvement in Human Infections

“…There are seven references for case reports and literature reviews included in our study ( Figure 2 ) [ 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. We analyzed all the references cited in these seven references.…”

“…When the literature review was not clearly systematized, we considered only the case report of the study [ 42 ]. We retrieved for further analyses 89 cases from the seven case reports and literature review references [ 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. After screening the rest of the 42 references, we retrieved 358 cases.…”

“…Some authors highlighted that they do not notice an apparent immune suppression [ 38 , 39 , 41 , 47 , 56 , 65 ]. However, because the opportunistic infections are the consequence of a lack of equilibrium with a host-microorganism, it is relevant to analyze both sides of the balance.…”

Microbiota of Dental Caries in Primary Teeth of a Costa Rican Child Population

“…They also identified the strains Sphingomonas paucimobilli and Pasteurella pnuemotropica, both Gram-negative. It is a relevant finding to highlight in this research because Sphingomonas paucimobilli is a bacterium located in aqueous media and is rare to find in humans; in addition, its persistence is related to infections and fever in pediatric patients (40). On the other hand, Pasteurella pnuemotropic is an opportunistic pathogen presented in the oral cavity of rodents, dogs, and cats.…”

The Association between Delayed Gut Microbiota Maturity in Pre-Term Infants and the Feeding Intolerance—A Pilot Study

“…According to the literature review, total bacterial communities differed significantly between healthy infants and those with NEC or sepsis, with Sphingomonas spp. being significantly associated with NEC [ 28 , 29 ]. An abundance of Proteobacteria and low rates of Firmicutes are associated with NEC [ 30 , 31 ].…”