J Med Cases
Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website http://www.journalmc.org

Case Report

Volume 5, Number 1, January 2014, pages 9-10


Burkholderia Cepacia: A Case Report

Oyeniyi Oyesinaa, b, William C. Anthonya

aUniversity of Maryland medical Center Midtown Campus, 827 Linden Ave, Baltimore, Maryland, USA
bCorresponding author: Oyeniyi Oyesina, University of Maryland medical Center Midtown Campus, 827 Linden Ave, Baltimore, Maryland, USA

Manuscript accepted for publication July 10, 2013
Short title: Burkholderia Cepacia
doi: https://doi.org/10.4021/jmc1425e

Abstract▴Top 

We present a case of a 60-year-old male with chronic kidney disease, stage V, hemodialysis-dependent, who was admitted to the hospital because of the occurrence of chills during hemodialysis. Burkholderia cepacia was identified in multiple blood cultures, temporally spaced. Analysis of the water supply at the dialysis center revealed no Burkholderia contamination.

Keywords: Burkholderia cepacia; Chronic kidney disease; Sepsis; Dialysis

Introduction▴Top 

Burkholderia cepacia was discovered in onion roots by Walter Burkholder in 1949 at Cornell University [1, 2]. B. cepacia refers to a group of several species of catalase-negative, non-lactose fermenting aerobic, motile, Gram-negative bacilli [2]. These organisms thrive in soil and aquatic environments [3, 4]. B. cepacia has antifungal activities, and for this reason it is used as a biological control against plant-fungi [1, 4]. In humans B. cepacia is a nosocomial organism that primarily affects patients with immune dysfunction or with preexisting damage to their respiratory epithelium. It is often resistant to multiple antibiotics and has been shown to grow in penicillin medium. It is known to contaminate intravenous fluids, bronchoscopes and urinary catheters [4]. In 2005, the Centers for Disease Control was notified of a multi-state mouthwash contamination from B. cepacia [3, 4].

Objective

To demonstrate a case of B. cepacia sepsis in a dialysis-dependent patient who had no pneumonia or any other identifiable source of infection. Analysis of the water supply at the dialysis center revealed no Burkholderia contamination.

Case Report▴Top 

A 60-year-old African-American male came to the emergency room with chills. The chills began two days prior after he completed his regular hemodialysis. He denied any neurological, cardiovascular, respiratory, gastrointestinal or musculoskeletal symptoms. His past medical history includes chronic kidney disease stage V secondary to rapidly progressive glomerulo nephritis, hypertension, anxiety and coronary artery disease. He has no significant surgical history other than cardiac catheterization for his coronary artery disease.

In the emergency room he had a temperature of 99.4 °F, heart rate of 100, respiratory rate of 16 and blood pressure of 120/77 mmHg. On examination he is well built, well nourished in no distress. His abdominal exam was normal, no tenderness or organomegaly with peritoneal catheter in place. His neurological, respiratory and cardiovascular exams were normal. His laboratory tests showed abnormal complete blood count; leukocytes were particularly elevated (Table 1). His urine cultures and X-ray of the chest were negative. He was hydrated with intravenous fluids, and three sets of blood were collected and sent for cultures. The peritoneal catheter was immediately removed and catheter tip was cultured and some blood culture was collected after removal of the catheter. He was then started on broad-spectrum antibiotics and given Tylenol.

Table 1.
Click to view
Table 1. Complete Blood Count
 

Infectious disease was consulted. On day 5, blood culture grew B. cepacia. Infectious disease recommended that the patient be treated with ciprofloxacin and piperacillin/tazobactam. His chills and fever had subsided. Blood cultures were again obtained and they were negative. The antibiotics had eradicated the disease. On further follow-up in the clinic he was asymptomatic and his leukocyte count was within normal limits. The dialysis center water was tested and it was negative for B. cepacia.

Discussion▴Top 

In order to ascertain cases of B. cepacia sepsis without pneumonia or no source was ever reported, we searched the American literature from 2007 to 2012. We did not find a single case reported. There were many reports of B. cepacia sepsis in patients with cystic fibrosis and some reports of catheter-induced B. cepacia bacteremia in hemodialysis patient [5]. Our case differs because the hemodialysis catheter tip in our patient was removed and cultured before antibiotics were started, and the culture was negative for B. cepacia.

Immunocompromised patients, patients with cystic fibrosis and dialysis-dependent patients are particularly vulnerable. Clinical manifestations are varied and run the gamut from asymptomatic colonization to necrotizing pneumonia and sepsis. Colonization in cystic fibrosis patients has been reported to be 3% [2].

Burkholderia species are often multi-drug-resistant, and treatment is challenging. The organisms are often sensitive to trimethoprim-sulfamethoxazole, meropenem and ceftazidime [6]. The optimal treatment regimen is not established. Intravenously administered antibiotic therapy, often in combination, has been successful.

In conclusion we report a case of sepsis associated with B. cepacia without any identifiable source of infection. It is our belief that this is the first reported case. The occurrence of B. cepacia sepsis in a dialysis-dependent patient with no obvious source requires additional study.

Conflicts of Interest

None.

Funding

None.


References▴Top 
  1. Bayram M, Babalik M, Bakan ND, Dongel I. Community-acquired Burkholderia cepacia pneumonia: a report of two immunocompetent patients. Tuberk Toraks. 2011;59(4):380-383.
    doi pubmed
  2. Zuckerman JB, Seder DB. Infection control practice in cystic fibrosis centers. Clin Chest Med. 2007;28(2):381-404.
    doi pubmed
  3. Centers for Disease Control and Prevention: Burkholderia cepacia in Healthcare Settings-Maryland, July 2012.
  4. Long. Priciples and Practice of Pediatric Infectious Diseases Revised reprint, 3rd ed. Churchill Livingstone, An Imprint of Elsevier. 2009.
  5. Mandell. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed. Churchill Livingstone, An Imprint of Elsevier. 2009.
  6. Zhou J, Chen Y, Tabibi S, Alba L, Garber E, Saiman L. Antimicrobial susceptibility and synergy studies of Burkholderia cepacia complex isolated from patients with cystic fibrosis. Antimicrob Agents Chemother. 2007;51(3):1085-1088.
    doi pubmed


This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Journal of Medical Cases is published by Elmer Press Inc.

 

Browse  Journals  

     

Journal of clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.            
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.