Rare Elizabethkingia anophelis meningitis case in a Danish male

Abstract

Introduction. Elizabethkingia anophelis is a Gram-negative, aerobic, non-motile rod belonging to the family Flavobacteriaceae. Over the last 5 years, it has emerged as an opportunistic human pathogen involved in neonatal meningitis and sepsis, as well as nosocomial outbreaks. It has been isolated from the midgut of the Anopheles gambiae mosquito, but there is no evidence for a role of the mosquito in human infections, and very little is known regarding the routes of transmission to humans. Recent studies, primarily from South-East Asia, suggest that E. anophelis, and not Elizabethkingia meningoseptica, is the predominant human pathogen of this genus. However, identification to the species level has been difficult due to the limitations of the current MALDI-TOF MS (matrix-associated laser desorption ionization-time of flight MS) systems for correct species identification.Case presentation. Here, we present a rare case of E. anophelis meningitis in a Danish male, who had a travel exposure to Malaysia 7 weeks before hospitalization. A multidrug-resistant Elizabethkingia species was isolated from blood and cerebrospinal fluid, and genomic sequencing was used to characterize the phylogenetic position of the isolate, which was determined as associated with previously described sublineage 11. The patient was successfully treated with intravenous moxifloxacin and rifampicin for 2 weeks with no major sequelae, but we did not find the source of transmission.Conclusion. All clinical microbiologists should be aware of the present limitations of the MALDI-TOF MS systems for correct species identification, and therefore we recommend the use of genome sequencing for the correct identification at the species and sublineage level.

Multidrug-resistant Elizabethkingia anophelis septicemia, meningitis, ventriculitis, and hydrocephalus in a preterm neonate: A rare complication of an emerging pathogen

“…E. anophelis could have been misidentified in the past due to the failure of MALDI-TOF mass spectrometry in identifying these strains, as the databases were lacking. [ 6 8 ] This organism appears to be commonly resistant to multiple drug classes, including aminoglycosides, third-generation cephalosporins, and carbapenems. [ 9 ] The unusual role of vancomycin for treatment of infection with Elizabethkingia species, a Gram-negative organism has been reported.…”

“…[ 2 ] Three more cases of uncomplicated neonatal meningitis were described in different parts of the world. [ 3 4 5 6 ] The development of ventriculitis and hydrocephalus is not yet mentioned. Here we describe a case of neonatal septicemia, meningitis, and ventriculitis leading to obstructive hydrocephalus with multidrug-resistant E. anophelis and the challenges involved in its management.…”

Which Plagues are Coming Next?

“…A newly uncovered bacterium, Elizabethkingia anophelis was discovered in 2011 in the midgut of an Anopheles gambiae mosquito [70][71][72][73]. Less than a decade since its discovery this pathogen has caused human disease in Asia [73][74][75], North America [76,77], Europe [72,78], and Africa [79]. The route of transmission remains unclear, although it is theorized mosquitoes transmit the bacteria to humans [80].…”

“…The pathogen recently gained international attention by a large outbreak occurring in Wisconsin, USA, where over 60 cases were identified and 18 deaths occurred [71]. Clinical symptoms may include mostly sepsis, meningitis, fever, bacteremia, and pneumonia [71,72,76,78], among others. Currently the case fatality rate is estimated between 23-70% [71][72][73][74]80].…”

How MALDI-TOF mass spectrometry can aid the diagnosis of hard-to-identify pathogenic bacteria – the rare and the unknown

“…Figure 1 depicts the overall similarity of mass spectra acquired from strains of the three main species of Elisabethkingia and characteristic peak patterns which can be used for their differentiation. Nielsen and coworkers reported the limitations of current MALDI-TOF MS systems in the identification of Elisabethkingia species [15]. An update of the MALDI Biotyper database and a supporting subtyping functionality are in preparation for 2019 (own unpublished results).…”