Chryseobacterium Indologenes Pneumonia -Case Presentation .

1. Dr.Hythum S. Mohamed
KAMC-Riyadh-February 2015

2.  25 years old female presented to the ER department in November 2014 with complaints of
fever , cough and shortness of breath .
 She was admitted as a case of CAP .
 She has PMH of ESRD on regular haemodialysis .
 After short stay in ER she had being unstable and transferred to the ICU .
 Blood and sputum cultures showed growth of MSSA.
 Pt improved after receiving Antibiotics and then transferred to the word after about one
week of ICU admission .
 After about one week of admission in the word she developed symptoms of HAP and being
unstable and then she needed ICU admission again .

3.  In ICU she required mechanical ventilator after short stay .
 Full septic screening including MERS-COV , TB screening was done and apart from positive
respiratory culture all were negative.
 Chest X-Ray showed bilateral infiltration more in the right side and pleural effusion .
 CT-Chest showed diffuse right lung opacity keeping with pneumonia , bilateral pleural
effusion small amount in the right side and moderate and loculated in the left side and also
cavity lesion in the left lower lung .
 Diagnosis was sever HAP ( Necrotizing Pneumonia ? +Empyema).

5.  Surgical treatment was done for Pt ( left upper and lower wedge resection + chest tube ) +
multiple antibiotics but not improved .
 pt improved after received definitive antibiotics .
 pt discharged from Hospital in a good condition after 41 days of admission .

6.  Respiratory Cultures ( Sputum and Tracheal aspirate ) showed Chryseobacterium
Indologenes which was sensitive to (Cefepime, ciprofloxacin and Bactrim ) , resistant to
(Imipenem , Meropenem , Piperacilin/ tazobactam , Amikacin and Gentamycin ) and
intermediate to Ceftazidime .
 During admission pt received Antimicrobials as :-
Ceftriaxone, Azithromycin , Moxifloxacin , Tazocin , Tameflu , Vancomycin , Linzolid ,
Meropenem , Imipenem , Colstine , Cloxacillin sodium , Gentamycin , Metronidazole ,Bactrim
and Ciprofloxacin .
 Pt improved on Bactrim + Ciprofloxacin for 12 days .

7.  Chryseobacterium is a genus of Gram
negative,nonmotile,oxidase- and indole-positive
aerobic bacilli .
 normally found in plants, soil, foodstuffs, and fresh
and marine water sources.
 It can survive in chlorine-treated water supplies, which
can lead to reservoirs for hospital-acquired infections.
 Chryseobacterium indologenes was first isolated from
the tracheal aspirate of a patient with ventilator-
associated pneumonia in 1993.
Chryseobacterium