ABSTRACT
BACKGROUND: Agrobacteria are Gram-negative tumorigenic plant pathogens that rarely cause infections in humans. METHODS: The authors describe a 7-year-old boy with acute lymphoblastic leukemia who carried a central venous catheter and developed bacteremia due to Agrobacterium radiobacter (A. radiobacter). RESULTS: Microbiological cure was achieved after administration of systemic ceftriaxone along with gentamicin lock therapy to the central venous catheter for 10 days. Catheter removal was not required, and the patient has not relapsed with bacteremia due to the same pathogen for more than 6 months. CONCLUSIONS: A. radiobacter is an emerging pathogen affecting immunocompromised children, particularly those with leukemia who carry central venous catheters. Although it has a low virulence, erratic susceptibility patterns, and high frequency of resistance to many antibiotics, ceftriaxone appears to be successful in treatment of most cases. Catheter removal for the clearance of bloodstream infections due to A. radiobacter may not be required in selected patients like the present case.
Subject(s)
Bacteremia/microbiology , Catheter-Related Infections/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Rhizobium/isolation & purification , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Catheter-Related Infections/diagnosis , Catheter-Related Infections/drug therapy , Catheterization, Central Venous , Ceftriaxone/therapeutic use , Child , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Humans , Immunocompromised Host , MaleABSTRACT
Nocardia farcinica is an emerging pathogen in immunocompromised patients, accounting for approximately 20% of Nocardia clinical isolates in various countries. A case of fatal N. farcinica bacteremia in a 52-year-old man with lung cancer is described. He was admitted with severe respiratory distress, and despite the early onset of empirical antibiotic treatment, he failed to respond and died of septic shock 24 hours later. N. farcinica was isolated from blood cultures obtained at hospital admission and was identified by conventional methods. Strain identification was confirmed by nucleotide sequencing of the 16S rRNA gene. N. farcinica bacteremia is a life-threatening infection. Because of the actinomycete's highly-resistant antibiotic profile, early identification and antibiotic susceptibility testing are necessary to improve the chances of survival.
Subject(s)
Immunocompromised Host , Lung Neoplasms/immunology , Nocardia Infections/diagnosis , Nocardia/classification , Shock, Septic/diagnosis , Anti-Bacterial Agents , Bacteremia/drug therapy , Bacteremia/microbiology , Base Sequence , DNA, Bacterial/analysis , Disease Progression , Drug Therapy, Combination/therapeutic use , Fatal Outcome , Greece , Humans , Lung Neoplasms/diagnosis , Male , Microbial Sensitivity Tests , Middle Aged , Molecular Sequence Data , Nocardia Infections/drug therapy , Polymerase Chain Reaction , Severity of Illness Index , Shock, Septic/drug therapyABSTRACT
Three cases of viridans group streptococcal bacteremia in 2 children with brain tumours and in 1 with autoimmune neutropenia are presented. All children were neutropenic. The 2 patients with malignancy also had mucositis. The isolated strains of viridans group streptococci showed considerable resistance to antibiotics. All patients were empirically treated with third generation cephalosporins and amikacin, before antibiotic sensitivities were available and recovered without complications. Viridans group streptococcal bacteremia should be suspected in neutropenic children, especially in the presence of mucositis. Prospective, randomized clinical trials of mouth antiseptics are needed to clarify the usefulness, if any, of such measures in the reduction of viridans group streptococcal bacteremia in this group of patients.
