• Users Online: 767
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 22  |  Issue : 1  |  Page : 53-55

A case of Chromobacterium violaceum from a newborn


Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India

Date of Submission16-Jun-2020
Date of Decision26-Jun-2020
Date of Acceptance06-Jul-2020
Date of Web Publication13-Aug-2020

Correspondence Address:
Dr. Swetha Sivaraman
Department of Microbiology, Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_17_20

Rights and Permissions
  Abstract 


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 Top


Chromobacterium violaceum, a common inhabitant of soil and water is a facultative anaerobic Gram-negative saprophytic bacillus, found mainly in tropical and subtropical climates.[1]

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.[2] Infections can progress to necrotising metastatic lesions and multiple abscess of the lung, liver, spleen, lymph node and brain with fatal septicaemia.[3] 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.[4]

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.[5] The first case in India was reported in North India in a six and half-year-old boy.[6]


  Case Report Top


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.[7]
Figure 1: Pustular lesion on the gluteal region

Click here to view
Figure 2: Pustular lesion on the dorsal aspect of the thumb

Click here to view


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:

  1. Violet pigment production
  2. 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 Top


C. violaceum was first described as a human pathogen in Malaysia in 1927.[8] 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.[2] 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.[6]

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.[9]

C. violaceum is intrinsically resistant to Penicillin, Ampicillin, and first generation Cephalosporins.[10] It is susceptible to Chloramphenicol, Trimethoprim-Sulfamethoxazole, Tetracycline, Ciprofloxacin, Cefepime and Imipenem.[11] 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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lin Yd, Majumdar SS, Hennessy J, Baird RW. The Spectrum of Chromobacterium violaceum Infections from a Single Geographic Location. Am J Trop Med Hyg 2016;94:710-6.  Back to cited text no. 1
    
2.
Kumar MR. Chromobacterium violaceum: A rare bacterium isolated from a wound over the scalp. Int J Appl Basic Med Res 2012;2:70-2.  Back to cited text no. 2
    
3.
Berebichez-Fridman R, Solano-Gálvez S, Copitin-Niconova NI, Ruy-Díaz Reynoso JA, Barrientos-Fortes T, Vázquez-López R. First isolation and antimicrobial susceptibility testing of Chromobacterium violaceum from oysters in Mexico. Rev Médica Hosp Gen México 2018;81:66-7.  Back to cited text no. 3
    
4.
Khadanga S, Karuna T, Dugar D, Satapathy SP. Chromobacterium violaceum-induced sepsis and multiorgan dysfunction, resembling melioidosis in an elderly diabetic patient: A case report with review of literature. J Lab Physicians 2017;9:325.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Madi DR, Vidyalakshmi K, Ramapuram J, Shetty AK. Successful Treatment of Chromobacterium violaceum Sepsis in a South Indian Adult. Am J Trop Med Hyg 2015;93:1066-7.  Back to cited text no. 5
    
6.
Lee J, Kim JS, Nahm CH, Choi W. Two cases of Chromobacterium violaceum infection after injury in a subtropical region. J Am Soc Microbiol 1999; volume 37:2068-70.  Back to cited text no. 6
    
7.
Parajuli NP, Bhetwal A, Ghimire S, Maharjan A, Shakya S, Satyal D, et al. Bacteremia caused by a rare pathogen - Chromobacterium violaceum: A case report from Nepal. Int J Gen Med 2016;9:441-6.  Back to cited text no. 7
    
8.
Saboo AR, Vijaykumar R, Save SU, Bavdekar SB. A rare nonfatal presentation of disseminated Chromobacterium violaceum sepsis. J Microbiol Immunol Infect 2015;48:574-7  Back to cited text no. 8
    
9.
Tiwari S, Pattanaik S, Beriha SS. Nonpigmented strain of Chromobacterium violaceum; causing neonatal septicemia: A rare case report. Indian J Pathol Microbiol 2017;60:427-9.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Karthik R, Pancharatnam P, Balaji V. Fatal Chromobacterium violaceum septicemia in a South Indian adult. J Infect Dev Ctries 2012;6:751-5  Back to cited text no. 10
    
11.
Ray P, Sharma J, Marak RS, Singhi S, Taneja N, Garg RK, et al. Chromobacterium violaceum septicaemia from North India. Indian J Med Res 2004;120:523-6.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
References
Article Figures

 Article Access Statistics
    Viewed95    
    Printed5    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal