|Year : 2020 | Volume
| Issue : 1 | Page : 53-55
A case of Chromobacterium violaceum from a newborn
Swetha Sivaraman, Ivy Viswamohanan, Ganga Raju Krishna, Ashish Jithendranath, Ramani Bai
Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India
|Date of Submission||16-Jun-2020|
|Date of Decision||26-Jun-2020|
|Date of Acceptance||06-Jul-2020|
|Date of Web Publication||13-Aug-2020|
Dr. Swetha Sivaraman
Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala
Source of Support: None, Conflict of Interest: None
Chromobacterium violaceum is a Gram-negative, facultative anaerobe. It is a common inhabitant of soil and water. It causes localised skin infection or localised lymphadenitis following contact with stagnant water or soil and then progresses to fulminant septicaemia with necrotising metastatic lesions. A three day-old girl presented with fever and multiple abscesses all over her body. On blood culture, C. violaceum was isolated. She had a history of consumption of holy water three days after birth. She was treated with Piperacillin-Tazobactam, Amikacin and Ciprofloxacin.
Keywords: Chromobacterium violaceum, facultative anaerobe, holy water
|How to cite this article:|
Sivaraman S, Viswamohanan I, Krishna GR, Jithendranath A, Bai R. A case of Chromobacterium violaceum from a newborn. J Acad Clin Microbiol 2020;22:53-5
|How to cite this URL:|
Sivaraman S, Viswamohanan I, Krishna GR, Jithendranath A, Bai R. A case of Chromobacterium violaceum from a newborn. J Acad Clin Microbiol [serial online] 2020 [cited 2020 Sep 27];22:53-5. Available from: http://www.jacmjournal.org/text.asp?2020/22/1/53/291890
| Introduction|| |
Chromobacterium violaceum, a common inhabitant of soil and water is a facultative anaerobic Gram-negative saprophytic bacillus, found mainly in tropical and subtropical climates.
Human infections caused by C. violaceum are infrequent. There are a few reported cases in several countries. Those infections appear after a skin contact with soil or contaminated water. Infections can progress to necrotising metastatic lesions and multiple abscess of the lung, liver, spleen, lymph node and brain with fatal septicaemia. Infections caused by this bacterium have a high lethality rate among survivors. It has been described that this organism is resistant to several antibiotics. Diagnosis may be delayed since C. violaceum may mimic melioidosis, especially in melioidosis endemic areas.
Human infections caused by C. violaceum are uncommon. Only 150 cases have been reported worldwide, including patients from Vietnam, Taiwan, Japan, the United States, Brazil, Argentina, Australia, Senegal, Cuba, Nigeria, Singapore and Sri Lanka. The first case in India was reported in North India in a six and half-year-old boy.
| Case Report|| |
A three-day-old girl from Trivandrum, Kerala, India, presented with fever and multiple abscess over her body. The abscess was present in the gluteal region [Figure 1] and dorsum of the thumb ([Figure 2] and was about 1.5 cm × 1.5 cm in size. There was no internal visceral involvement, and straw coloured pus was oozing from the abscess. The crops appeared simultaneously. She was a full-term baby with birth weight 4 kg and delivered by the lower segment caesarean section due to cephalopelvic disproportion and thin meconium-stained amniotic fluid. The lower segment caesarean section was done in a local hospital on 28th May, 2019. There was no trauma to the baby during lower segment caesarean section. No injection was given to the baby immediately after birth. She had a history of consumption of holy water three days after birth and lesions developed on the same day. She was empirically started with Ampicillin and Amikacin on the third day when the abscess developed. The baby was referred to our hospital for further management. Complete blood count showed neutrophilic leucocytosis. Total count was markedly elevated and C-reactive protein was 194.08 mg/L. X-ray of the abdomen was taken due to abdominal distension which showed mild hepatomegaly. Peripheral smear showed neutrophilic leucocytosis with toxic change and severe thrombocytopenia. The initial diagnosis was Staphylococcal septicaemia. The local abscesses were drained and pus was sent to the laboratory for culture and sensitivity which showed no growth of organisms. Single blood sample was sent which after 24 h of incubation was subcultured on blood agar, chocolate agar and MacConkey agar.
Blood agar showed low convex smooth beta haemolytic colonies with a dark violet metallic sheen due to violacein production.
Chocolate agar showed smooth low convex colonies with a dark violet metallic sheen.
MacConkey agar showed pale lactose-fermenting colonies with a dark metallic sheen.
The isolate was identified as C. violaceum on the following:
- Violet pigment production
- Characteristic identifying features:
- Catalase test positive
- Oxidase test positive
- Indole test was negative
- Citrate was utilised
- Triple sugar iron agar-alkaline slant with acidic butt without gas and H2S
- Mannitol motility-non-fermenter and motile
- Nitrate was reduced
- Urea was not hydrolysed
- Methyl red test negative
- Voges–Proskauer test negative
- Arginine was dihydrolysed.
Antibiotic susceptibility was done by disc-diffusion method test according to the Clinical and Laboratory Standards Institute guidelines. It was sensitive to Gentamicin, Netilmicin, Amikacin, Ceftazidime, Tetracycline, Ciprofloxacin, Cefepime, Trimethoprim- Sulfamethoxazole, Aztreonam, Piperacillin-Tazobactam, Imipenem and Meropenem.
The holy water on subculturing in blood, chocolate and MacConkey agar showed heavy mixed growth of Gram-negative bacteria. Multiple tube method was also done for holy water and showed colour change to yellow and gas production. Water showed heavy mixed growth of C. violaceum and Escherichia coli and was sensitive to Amikacin, Gentamicin, Netilmicin, Ciprofloxacin, Ceftazidime, Tetracycline, Cefepime, Trimethoprim-Sulfamethoxazole, Piperacillin-Tazobactem, Imipenem and Meropenem.
The baby was empirically started on Ampicillin and Amikacin. There was recurrence of fever and was changed to Piperacillin-Tazobactam, Amikacin, Ciprofloxacin and syrup Trimethoprim-Sulfamethoxazole. The baby's clinical condition improved and was discharged on post-natal day 12.
| Discussion|| |
C. violaceum was first described as a human pathogen in Malaysia in 1927. The disease typically starts with a localised skin infection or localised lymphadenitis following contact with soil or stagnant water and progresses to periorbital, ocular infections and chronic granulomatous lesions. C. violaceum can be a cause of community acquired septicaemia, especially among patients in a rural community with a history of contact with soil and stagnant water and in newborns.
Oxidase-positive, non-pigmented strains may be confused with Vibrio or Aeromonas. These may be differentiated by their ability to grow in a nutrient broth with 0% NaCl, their fermentation of D-glucose, mannitol, maltose and their lysine and ornithine decarboxylase activities.
C. violaceum is intrinsically resistant to Penicillin, Ampicillin, and first generation Cephalosporins. It is susceptible to Chloramphenicol, Trimethoprim-Sulfamethoxazole, Tetracycline, Ciprofloxacin, Cefepime and Imipenem. Therefore, Carbapenem or Fluoroquinolones can be used as appropriate initial choice for C. violaceum due to unavailability of recommended therapeutic guidelines. Timely diagnosis and aggressive antibiotic therapy is a pivotal factor for effective management. In our case, timely intervention with the administration of Aminoglycosides and Piperacillin-Tazobactam to which the organism was sensitive helped in the proper management of illness.
She had a history of consumption of contaminated holy water on the third day of birth. The holy water was stored in the refrigderator by the family members. The organism may have entered baby through contaminated holy water.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]