Recurrent Achromobacter xylosoxidans Bacteremia Associated with Persistent Lymph Node Infection in a Patient with Hyper-Immunoglobulin M Syndrome

Abstract

Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important cause of bacteremia in immunocompromised patients, and strains are usually multiply resistant to antimicrobial therapy. We report an immunocompromised patient with hyper-immunoglobulin M syndrome who suffered from 14 documented episodes of A. xylosoxidans bacteremia. Each episode was treated and resulted in rapid clinical improvement, with blood cultures testing negative for bacteria. Between episodes, A. xylosoxidans was isolated from an excised right axillary lymph node, whereas the culture of the central venous catheter, removed at the same time, was negative. Multiple cultures from sputum, stool, and urine samples, as well as from gastrointestinal biopsies or environmental sources, were negative. Results from antibiotic sensitivity testing and pulsed-field gel electrophoresis suggested that a single strain of A. xylosoxidans caused the recurrent bacteremias in this patient; this strain originated from persistently infected lymph nodes. Lymphoid hyperplasia is a prominent characteristic of hyper-IgM syndrome and may serve as a source of bacteremia with low-pathogenicity organisms.

Achromobacter xylosoxidans Genomic Characterization and Correlation of Randomly Amplified Polymorphic DNA Profiles of Cystic Fibrosis Patients

“…The U.S. Cystic Fibrosis Foundation's National Patient Registry reported an increase of 4.5%, from 1995 to 2002 (1, 2), in the frequency of isolation of this microorganism from CF patients. Recently, A. xylosoxidans has been considered a nosocomial pathogen, particularly in immunocompromised patients, causing a variety of infections, including bacteremia, meningitis, pneumonia, and peritonitis (8,23,25). Achromobacter spp.…”

Infection Prevention and Control Guideline for Cystic Fibrosis: 2013 Update

“…A. xylosoxidans is an opportunistic pathogen that causes healthcare-associated infections, including bacteremia, meningitis, pneumonia, endocarditis, peritonitis, osteomyelitis, urinary tract infection, and endophthalmitis, in vulnerable hosts, including neonates, burn victims, and other immunocompromised patients. [191][192][193] Among 341 individuals with CF in the United States infected with Achromobacter, 42% were infected with A. xylosoxidans, and 23.5% were infected with Achromobacter rhulandii. 190 In 2 small single-center studies, Achromobacterinfected individuals each harbored genotypically distinct strains.…”

Achromobacter xylosoxidans Infection Presenting as a Pulmonary Nodule Mimicking Cancer

“…Mortality rates of up to 80% have been reported in infections of A. xylosoxidans in neonates (9). The case mortality rate is reported to be as high as 30% in adult cases of bacteremia and up to 65% in cases of meningitis, endocarditis, and pneumonia (9,44). Gomez-Cerezo et al identified risk factors associated with increased mortality to include older age (over 65 years) and neutropenia (17).…”