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Cepacia Syndrome in a Non-Cystic Fibrosis Patient.

Hauser N, Orsini J - Case Rep Infect Dis (2015)

Bottom Line: Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions.This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome.A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA.

ABSTRACT
Burkholderia (formerly Pseudomonas) cepacia complex is a known serious threat to patients with cystic fibrosis, in whom it has the potential to cause the fatal combination of necrotizing pneumonia, worsening respiratory failure, and bacteremia, known as Cepacia syndrome. The potential for this pathogen to infect non-cystic fibrosis patients is limited and its epidemiology is poorly understood. Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions. We present a case of a 64-year-old man with Streptococcus pneumoniae community-acquired pneumonia whose hospital course was complicated by developing cavitary lung lesions, bacteremia, and acute respiratory distress syndrome. Repeated tracheal aspirate and blood cultures grew Burkholderia cepacia. Our case appears to be the first report of Cepacia syndrome in a patient without cystic fibrosis. This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome. A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.

No MeSH data available.


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Mentions: Remarkable laboratory findings included a sodium level of 126 mmol/L (135–145), a bicarbonate level of 7 mmol/L (24–31), a creatinine level of 1.9 mg/L (0.8–2.0), and a glucose of 687 mg/dL (65–115). Arterial blood gas (ABG) showed paO2 of 59 mmHg (80–100) on room air. Chest X-ray (CXR) demonstrated right middle lobe consolidation (Figure 1). The patient was admitted to the intensive care unit (ICU) with diagnoses of diabetic ketoacidosis (DKA) and acute hypoxemic respiratory failure secondary to community-acquired pneumonia. Empiric intravenous antimicrobial therapy was initiated comprising ceftriaxone (2 grams every 12 hours) and azithromycin (500 milligrams daily). Blood cultures obtained on admission grew Streptococcus pneumoniae, and azithromycin was discontinued. The patient's medical condition improved and he was transferred to a medical ward on hospital day 2. His clinical course was complicated by worsening tachypnea, leukocytosis of 21,700/mm3 (4,500–10,400), and hypoxemia. ABG while receiving 40% venturi mask showed paO2 of 46 mmHg. Repeat CXR showed worsening bilateral infiltrates (Figure 2). He was intubated, placed on mechanical ventilation, and readmitted to the ICU with the diagnosis of acute respiratory distress syndrome (ARDS). Ceftriaxone was replaced with intravenous vancomycin (1 gram every 12 hours) and cefepime (2 grams every 12 hours). A chest computed tomography (CT) with contrast showed a large consolidation with air bronchograms involving the superior segment of the right lower lobe, with a cavitary-like lesion with air fluid levels in the posterior aspect of the right hemithorax, suggestive of empyema, necrotizing pneumonia, or abscess (Figure 3). His ICU course was further complicated by refractory shock and multiorgan dysfunction syndrome. Blood and bronchoalveolar lavage (BAL) cultures obtained in the ICU grew Burkholderia cepacia complex. Antimicrobial therapy was substituted with doripenem 250 milligrams intravenously every 8 hours, adjusted to creatinine clearance. Despite all medical therapy, the patient expired on the 30th day of ICU admission.


Cepacia Syndrome in a Non-Cystic Fibrosis Patient.

Hauser N, Orsini J - Case Rep Infect Dis (2015)

© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555446&req=5

Mentions: Remarkable laboratory findings included a sodium level of 126 mmol/L (135–145), a bicarbonate level of 7 mmol/L (24–31), a creatinine level of 1.9 mg/L (0.8–2.0), and a glucose of 687 mg/dL (65–115). Arterial blood gas (ABG) showed paO2 of 59 mmHg (80–100) on room air. Chest X-ray (CXR) demonstrated right middle lobe consolidation (Figure 1). The patient was admitted to the intensive care unit (ICU) with diagnoses of diabetic ketoacidosis (DKA) and acute hypoxemic respiratory failure secondary to community-acquired pneumonia. Empiric intravenous antimicrobial therapy was initiated comprising ceftriaxone (2 grams every 12 hours) and azithromycin (500 milligrams daily). Blood cultures obtained on admission grew Streptococcus pneumoniae, and azithromycin was discontinued. The patient's medical condition improved and he was transferred to a medical ward on hospital day 2. His clinical course was complicated by worsening tachypnea, leukocytosis of 21,700/mm3 (4,500–10,400), and hypoxemia. ABG while receiving 40% venturi mask showed paO2 of 46 mmHg. Repeat CXR showed worsening bilateral infiltrates (Figure 2). He was intubated, placed on mechanical ventilation, and readmitted to the ICU with the diagnosis of acute respiratory distress syndrome (ARDS). Ceftriaxone was replaced with intravenous vancomycin (1 gram every 12 hours) and cefepime (2 grams every 12 hours). A chest computed tomography (CT) with contrast showed a large consolidation with air bronchograms involving the superior segment of the right lower lobe, with a cavitary-like lesion with air fluid levels in the posterior aspect of the right hemithorax, suggestive of empyema, necrotizing pneumonia, or abscess (Figure 3). His ICU course was further complicated by refractory shock and multiorgan dysfunction syndrome. Blood and bronchoalveolar lavage (BAL) cultures obtained in the ICU grew Burkholderia cepacia complex. Antimicrobial therapy was substituted with doripenem 250 milligrams intravenously every 8 hours, adjusted to creatinine clearance. Despite all medical therapy, the patient expired on the 30th day of ICU admission.

Bottom Line: Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions.This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome.A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA.

ABSTRACT
Burkholderia (formerly Pseudomonas) cepacia complex is a known serious threat to patients with cystic fibrosis, in whom it has the potential to cause the fatal combination of necrotizing pneumonia, worsening respiratory failure, and bacteremia, known as Cepacia syndrome. The potential for this pathogen to infect non-cystic fibrosis patients is limited and its epidemiology is poorly understood. Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions. We present a case of a 64-year-old man with Streptococcus pneumoniae community-acquired pneumonia whose hospital course was complicated by developing cavitary lung lesions, bacteremia, and acute respiratory distress syndrome. Repeated tracheal aspirate and blood cultures grew Burkholderia cepacia. Our case appears to be the first report of Cepacia syndrome in a patient without cystic fibrosis. This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome. A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.

No MeSH data available.


Related in: MedlinePlus