Skull base osteomyelitis by <i>Pandoraea apista</i>: An unusual pathogen at unusual location – A case report

Patil, Ninad Ramesh; Tripathi, Manjul; Charaya, Kshitij; Angrup, Archana; Ahuja, Chirag; Mohindra, Sandeep

doi:10.25259/sni_472_2021

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…Other bacteria like streptococcus (14%) and Staphylococcus (9%) were also found. Atypical organisms like Pandoraea apista (20) , Nocardia (21) , Corynebacterium (22) and nonanthrax bacillus (23) were also isolated. Interestingly, no organism was isolated in 34% of patients.…”

Section: Discussionmentioning

confidence: 99%

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

P.,

Upreti,

Paramasivam

et al. 2024

J Neurol Surg B Skull Base

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Objectives: Based on current evidence, this systematic review focuses on various grey areas related to these patients' diagnosis, management and follow-up in central skull base osteomyelitis (CSBO). Study design: A systematic review of all case reports and observational studies. Methods: We systematically searched PubMed, Scopus database, Cochrane database, UK clinicaltrails.gov registry, and WHO ICTRP and included all reports as per our inclusion criteria. Data was analyzed systematically, and we made essential observations. Results: Out of 179 articles, 25 were selected according to inclusion criteria and quality assessment. Among the 44 patients, refractory headache (95%) was the most common presentation, followed by cranial nerve paralysis (82%) and Pseudomonas (32%) as the most common bacteria. Contrary to the available literature the disease cure was worse in those who underwent targeted biopsy (64% VS 36%, P = 0.023) and surgical debridement (61% vs 39%, P = 0.013) in the late stages of the disease. Conclusions: Otogenic osteomyelitis can spread to central skull bones in the absence of obvious ear symptoms. Early diagnosis and intervention of CSBO before progression to late stages can help decrease significant morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

P.,

Upreti,

Paramasivam

et al. 2024

J Neurol Surg B Skull Base

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“…Among the 21 isolated cases, seven were Pandoraea pnomenusa , 5 , 9–12 five were Pandoraea Apista, 5 , 13–15 three were Pandoraea sputorum , 16 , 17 two were Pandoraea norimbergensis , 1 and four were unidentified Pandoraea species. 5 , 18 , 19 Ten (47.6%) were isolated from blood, eight from the respiratory samples, one from the maxillary sinus, 5 one from the hemodialysis catheter, 16 and one from the skull base 14 (see Table 2 ). To our knowledge, only four non-CF patients infected by Pandoraea species were reported from China.…”

Section: Discussionmentioning

confidence: 99%

Sepsis Due to Pandoraea sputorum Infection After Multiple Trauma in a Non-Cystic Fibrosis Patient: A Case Report from Southeast China

Ma¹,

Zou²,

Lin³

et al. 2022

IDR

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Pandoraea sputorum ( P. sputorum ) infection is of great concern as these gram-negative bacillus species are multidrug-resistant and usually isolated from the patients’ respiratory tract suffering from cystic fibrosis (CF). A few cases of infection have also been reported in non-CF patients due to its rare pathogenic nature with unclear and overlapping clinical, biochemical, and microbiological characteristics with other species. Here, we report an unusual case of a 46-year-old non-CF female, who presented with multiple pelvic fractures, acute traumatic brain injury, multiple rib fractures, and multiple burns (18% of the total body surface area, II°) by the collapse of a brick kiln, suffered from P. sputorum sepsis due to wound infection. Pandoraea species were isolated both from her blood and wound secretion. Antibiotic susceptibility testing indicated susceptibility to imipenem, tetracyclines, sulfamethoxazole, and ampicillin/sulbactam but resistance to meropenem, quinolones, aminoglycosides, and other beta-lactams. 16S ribosomal RNA (rRNA) PCR assays and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) were used to confirm the bacteria as P. sputorum . After effective anti-infection of intravenous antibiotics (imipenem 1.0 Q8H with tigecycline 50 mg Q12H for 14 days), wound care, and other comprehensive treatment for two months, the patient improved and was discharged from the hospital eventually. After reviewing the literature, we observed that the susceptibility results of Pandoraea species were often multidrug-resistant and had a unique pattern of being resistant to meropenem but sensitive to imipenem. Biofilm formation, carbapenemase production, and unique gene procession differed from the environmental isolates could help explain its resistance. This case report highlights the potential virulence of Pandoraea species as a pathogen in patients with no underlying disease. Although they are often multi-resistant, imipenem can be a preferred treatment for Pandoraea species in the earliest identification steps.

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Outbreak of Pandoraea commovens among Non–Cystic Fibrosis Intensive Care Patients, Germany, 2019–2021

Kruis,

Menzel,

Schwarzer

et al. 2023

Emerg. Infect. Dis.

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Pandoraea spp. are gram-negative, nonfermenting rods mainly known to infect patients with cystic fibrosis (CF). Outbreaks have been reported from several CF centers. We report a Pandoraea spp. outbreak comprising 24 non-CF patients at a large university hospital and a neighboring heart center in Germany during July 2019–December 2021. Common features in the patients were critical illness, invasive ventilation, antimicrobial pretreatment, and preceding surgery. Complicated and relapsing clinical courses were observed in cases with intraabdominal infections but not those with lower respiratory tract infections. Genomic analysis of 15 isolates identified Pandoraea commovens as the genetically most similar species and confirmed the clonality of the outbreak strain, designated P. commovens strain LB-19-202-79. The strain exhibited resistance to most antimicrobial drugs except ampicillin/sulbactam, imipenem, and trimethoprim/sulfamethoxazole. Our findings suggest Pandoraea spp. can spread among non-CF patients and underscore that clinicians and microbiologists should be vigilant in detecting and assessing unusual pathogens.

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Skull base osteomyelitis by Pandoraea apista: An unusual pathogen at unusual location – A case report

Cited by 4 publications

References 17 publications

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

Current Evidence in the Management of Central Skull Base Osteomyelitis: A Systematic Review

Sepsis Due to Pandoraea sputorum Infection After Multiple Trauma in a Non-Cystic Fibrosis Patient: A Case Report from Southeast China

Outbreak of Pandoraea commovens among Non–Cystic Fibrosis Intensive Care Patients, Germany, 2019–2021

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