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Elizabethkingia meningoseptica


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Elizabethkingia meningoseptica an emerging infection

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Elizabethkingia meningoseptica

  2. 2. Elizabethkingia meningoseptica•Elizabethkingia meningoseptica is a gram- negative rod-shaped bacterium widely distributed in nature (e.g. fresh water, salt water, or soil). It may be normally present in fish and frogs but is not normally present in human microflora. 4/6/2016 Dr.T.V.Rao MD 2
  3. 3. History of Elizabethkingia •In 1959, the American bacteriologist Elizabeth O. King (who isolated Kingella in 1960) was studying unclassified bacteria associated with paediatric meningitis at the CDC in Atlanta, 4/6/2016 Dr.T.V.Rao MD 3
  4. 4. Important Bacteria stable and adopts to Environment •Elizabethkingia meningoseptica has been deemed a potentially important threat to patients in critical care areas because of its multidrug-resistant phenotype and its ability to adapt to various environments. 4/6/2016 Dr.T.V.Rao MD 4
  5. 5. Elizabethkingia is found in the environment •Commonly found in the environment, particularly in soil and water, Elizabethkingia rarely causes disease in otherwise healthy individuals. 4/6/2016 Dr.T.V.Rao MD 5
  6. 6. Uncommon pathogen and Respiratory colonizer •Elizabethkingia are bacteria that are rarely reported to cause illness in humans, and are uncommon colonizers of the respiratory tract 4/6/2016 Dr.T.V.Rao MD 6
  7. 7. Present outbreak •In this outbreak, the bacteria primarily infect older adults and those who have serious underlying health conditions.The infection typically presents as septicaemia and can be deadly if not treated early with appropriate antibiotics. 4/6/2016 Dr.T.V.Rao MD 7
  8. 8. General Characteristics E. meningoseptica •E. meningoseptica is a species of Gram- negative, obligate aerobic, non- fastidious, non-spore forming, nonfermentative; nonmotile; slender; slightly curved rod; 4/6/2016 Dr.T.V.Rao MD 8
  9. 9. Elizabethkingia •Elizabethkingia is a genus of bacteria commonly found in the environment worldwide and has been detected in soil, river water and reservoirs. 4/6/2016 Dr.T.V.Rao MD 9
  10. 10. Elizabethkingia meningoseptica on (a) sheep blood agar and (b) MacConkey agar 4/6/2016 Dr.T.V.Rao MD 10
  11. 11. Magnified view of the Colonies ofElizabethkingia anophelis • Three individual Elizabethkingia anophelis colonies growing next to each other on blood agar. Photo courtesy CDC 4/6/2016 Dr.T.V.Rao MD 11
  12. 12. Biochemically reacting • Catalase positive, oxidase positive, and indole-positive, OF glucose ox+/F- , urease negative (contrast E. miricola which is urease positive), mannitol positive, non-nitrate-reducing saprophytic bacilli. It is gelatinase, esculin, ONPG & DNAse positive. Chryseobacteria (Flavobacteria) are in general indole positive in contrast to most other nonfermenters, however the reaction may be weak. 4/6/2016 Dr.T.V.Rao MD 12
  13. 13. Growth Characters • E. meningoseptica grows well in regular incubators on blood agar and chocolate agar. Colonies are very pale yellow and may not be easily evident at 24 hours. E. meningoseptica strains either are not pigmented or produce a weak yellow nondiffusible pigment 4/6/2016 Dr.T.V.Rao MD 13
  14. 14. Infection •E. meningoseptica predominantly causes outbreaks of meningitis in premature new-borns and infants in neonatal intensive care units of underdeveloped countries. 4/6/2016 Dr.T.V.Rao MD 14
  15. 15. Transmission and Sources of the Infection • Neonatal infections due to C. meningosepticum could be through vertical transmission; however, no data about this kind of transmission of the organism is available. As many interventions (endotracheal intubation, central and peripheral intravascular catheterization, etc.) are made in the neonatal intensive care units (NICUs) 4/6/2016 Dr.T.V.Rao MD 15
  16. 16. Can be a nosocomial Infection • Majority of the C. meningosepticum infections reported have been in NICUs, the infections of these neonates are often considered as nosocomial 4/6/2016 Dr.T.V.Rao MD 16
  17. 17. Infection •Some of the outbreaks have been linked to sources like contaminated lipid stock bottles, contaminated venous catheter lines and nutritional solution, and tap water.The bacterium is also a rare cause of nosocomial pneumonia, endocarditis, postoperative bacteremia, and meningitis in immunocompromised adults. 4/6/2016 Dr.T.V.Rao MD 17
  18. 18. Infection •Only recently has it also been found to cause soft tissue infection and sepsis in the immunocompetent and in a case of a fatal necrotizing fasciitis in a diabetic patient.4/6/2016 Dr.T.V.Rao MD 18
  19. 19. Current methods to identify • State clinical microbiology laboratories can characterize the isolates using pulsed- field gel electrophoresis, a method that can identify the Elizabethkingia genus correctly. Isolates sent to CDC's Special Bacteriology Reference Laboratory are confirmed as the species E anophelis on the basis of the pathogen's protein profile, acquired using the mass spectrometry method MALDI-ToF (matrix-assisted laser desorption/ionization time-of- flight), and optical mapping of the bacterial genome. 4/6/2016 Dr.T.V.Rao MD 19
  20. 20. Treatment and Drug resistant patterns• This bacterium is usually multiresistant to antibiotics typically prescribed for treating gram-negative bacterial infections, including extended-spectrum beta- lactam agents (due to production by most strains of two beta lactamases: one ESBL and one Class B Carbapenem-Hydrolyzing metallolactamase), aminoglycosides, tetracycline, and chloramphenicol. 4/6/2016 Dr.T.V.Rao MD 20
  21. 21. 6 day old Blood agar growth of Elizabethkingia meningioseptica • 6 day old Blood agar growth of Elizabethkingia meningioseptica with 5ug vancomycin (with a zone of clearing) and 10 ug colistin disks. This strain did not produce the flexirubin pigment. Like Burkholderia cepacia this organism can be Colistin resistant and partiallyVancomycin sensitive • Copy right of the picture and protocol permission is granted to copy, distribute and/or modify this document under the terms of the GNU Free Documentation License, Version 1.2 or any later version published by the Free Software Foundation; with no Invariant Sections, no Front- Cover Texts, and no Back-Cover Texts. A copy of the license is included in the section entitled GNU Free Documentation License. 4/6/2016 Dr.T.V.Rao MD 21
  22. 22. Choosing the Antibiotics •Though vancomycin has been used in the past, its high MIC (16 µg/ml) has led to a search for alternatives, especially for meningitis. Presently ciprofloxacin, minocycline, trimethoprim- sulfamethoxazole, rifampin and novobiocin are considered good alternatives. 4/6/2016 Dr.T.V.Rao MD 22
  23. 23. Predictors of poor outcome•Hypoalbuminemia, increased pulse rate at the onset of infection, and central venous line infection were associated with a poor outcome 4/6/2016 Dr.T.V.Rao MD 23
  24. 24. Trends in management of outbreaks • CDC and the affected states continue to work toward managing the ongoing outbreak. The unexpected number of infections with this unusual pathogen reminds us of the importance of new and emerging technologies, such as advanced molecular detection and Microbe Net, to quickly detect and track rare and deadly pathogens like Elizabethkingia.4/6/2016 Dr.T.V.Rao MD 24
  25. 25. . Infection Control Interventions • Outbreaks of Gram-negative bacterial infections are usually due to transient carriage of the organisms on the hands of healthcare workers . Susceptible patients may become colonized after acquiring the organism from the healthcare worker, and infection may or may not develop. • Hand washing by Health care workers potentially stops spread 4/6/2016 Dr.T.V.Rao MD 25
  26. 26. The Medical Profession Need more awareness on the emerging infection•In addition to reinforcement of standard infection control measures, actions that have successfully terminated E. meningoseptica outbreaks include pre-emptive contact isolation, systematic investigations to identify the source of the bacterium and thorough cleaning of equipment and environmental surfaces. As the clinical complexity and incidence of E. meningoseptica infections increase, there is a need for heightened awareness of the potential for this bacterium to cause outbreaks 4/6/2016 Dr.T.V.Rao MD 26
  27. 27. Resources and References • CDC on Elizabethkingia • Medscape Infectious diseases • WIKIPEDIA ON LINE RESOURCE • Review Article Elizabethkingia meningosepticum (Chryseobacterium meningosepticum) Infections in Children Mehmet Ceyhan and Melda Celik International Journal of PediatricsVolume 2011 (2011), Article ID 215237, 7 pages 4/6/2016 Dr.T.V.Rao MD 27
  28. 28. •Program Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals for awareness on the emerging trends on Elizabethkingia meningoseptica • Email • 4/6/2016 Dr.T.V.Rao MD 28