Urinary Tract Infection By Chromobacterium Violaceum

Abstract

A 19-year-male attended the outpatient department of IMS and SUM hospital, Bhubaneswar, India in Septmber, 2013 with chief complaints of burning micturation, fever with chills since seven days and pain in lower abdomen for three days. He had no past history of similar symptoms or any significant ailments. Abdominal examination revealed mild supra pubic tenderness. He was empirically treated with amoxicillin-clavulanic acid for urinary tract infection after advising necessary investigations. Laboratory findings showed a raised total leucocyte count (21,000/cmm) with relative neutrophilia (86%). Routine examination of urine showed albuminuria along with 8-10 pus cells per high power field with bacteriuria and occasional granular cast. Clean catch midstream urine sample plated on CLED medium revealed significant (>10 5 CFU/ml) growth of single type of colonies of 2-3 mm diameter producing violet non-diffusible pigment [Table/ Fig-1] after overnight aerobic incubation at 37°C. These organisms were gram negative, motile bacilli, catalase and oxidase positive, fermented glucose with production of acid without any gas. The bacterium was indole negative, non lactose fermenter on TSI media, utilized citrate, reduced nitrate, fermented mannitol and decarboxylated arginine. When incubated overnight anaerobically; there was no pigment formation which appeared after placing the plate for few hours under aerobic conditions. With these biochemical characters and pigment production it was identified as Chromobacterium violaceum. This was further confirmed by Vitek-2 system (BioMerieux, France) using GN card. Antibiogram Fig-2]. The organism was found to be susceptible to ciprofloxacin, cotrimoxazole, imipenem, nitrofurantoin and cefotaxime and resistant to amoxicillin-clavulanic acid. The initial antibiotic was changed to ciprofloxacin as per the sensitivity report and continued for one week. Due to propensity of the organism to develop septicemia, blood culture was done which did not yield any growth. Other tests like that for HIV, HBsAg, diabetes screening were negative. After seven days of antibiotic treatment there was a marked clinical improvement and repeated urine examination did not show any significant finding.

Sequential Mycoplasma pneumoniae pneumonia and Chromobacterium violaceum skin abscess in a pediatric patient

“…The most common presenting symptoms of human Chromobacterium violaceum infection are fever, sepsis, skin lesions, abdominal pain, and clinical syndrome of localized skin and soft tissue infection, lymphadenitis and gastroenteritis [8,10,16]. During the infection progression bacteremia and disseminated infection involving various organ systems can result in urinary tract infection, arthritis, osteomyelitis, abscesses in lung, brain and other viscera, meningitis, endocarditis, endophthalmitis, otitis media, vaginitis, haemophagocytic syndrome and multi-organ failure [8,10,16].…”

“…During the infection progression bacteremia and disseminated infection involving various organ systems can result in urinary tract infection, arthritis, osteomyelitis, abscesses in lung, brain and other viscera, meningitis, endocarditis, endophthalmitis, otitis media, vaginitis, haemophagocytic syndrome and multi-organ failure [8,10,16].…”

The Spectrum of Chromobacterium violaceum Infections from a Single Geographic Location

“…2 A total of 154 cases of C. violaceum have been previously published. Location data available for 143 cases reveal a worldwide tropical distribution comprising western Pacific (Vietnam, Japan, Korea, Cambodia, Malaysia, China, Australia, Singapore, Laos, and Papua New Guinea) with 49 cases (34.3%), [3][4][5][6][7][8][9][10][11][12] the Americas with 46 cases (30.0%), 3,13,14 southeast Asia (Thailand, India, Sri Lanka, and Nepal) with 23 cases (16.0%), 3,[15][16][17][18][19][20][21][22] Africa with 22 cases (15.4%), 23,24 Persian Gulf with two cases (1.4%), 25 and Europe with one case (0.7%).…”

Successful Treatment of Chromobacterium violaceum Sepsis in a South Indian Adult

“…3 The review of the literature revealed only six cases of Chromobacterium infection in adults from India. [5][6][7][8][9][10] Among them only two case reports have documented C. violaceum septicemia. 5,9 The outcome was fatal in one case, 5 but unknown in the other case.…”