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Year : 2015  |  Volume : 58  |  Issue : 3  |  Page : 384-386
Brevundimonas diminuta bacteremia in a man with myelodysplastic syndromes

Department of Laboratory Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu 210029, P. R. China

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Date of Web Publication14-Aug-2015


Brevundimonas diminuta are ubiquitous in the environment, but are infrequently isolated from clinical samples. Here we report a case of B. diminuta bacteremia in a man with myelodysplastic syndromes (MDS) at a teaching hospital in China and review the previously reported cases. The organism was confirmed by culture and 16s rRNA sequence analysis with highly sensitivity to broad-spectrum antibiotics. Our report and other cases demonstrated that the optimal therapeutic duration for B. diminuta infections in various situations remains to be established.

Keywords: Bacteremia, Brevundimonas diminuta, myelodysplastic syndromes

How to cite this article:
Cao H, Li M, Yang X, Zhang C. Brevundimonas diminuta bacteremia in a man with myelodysplastic syndromes. Indian J Pathol Microbiol 2015;58:384-6

How to cite this URL:
Cao H, Li M, Yang X, Zhang C. Brevundimonas diminuta bacteremia in a man with myelodysplastic syndromes. Indian J Pathol Microbiol [serial online] 2015 [cited 2022 Jan 22];58:384-6. Available from: https://www.ijpmonline.org/text.asp?2015/58/3/384/162920

   Introduction Top

Brevundimonas diminuta is formerly classified as a member of group IV of the genus Pseudomonas. B. diminuta and B. vesicularis were reclassified as a new genus (Brevundimonas) because of their distinct 16s rRNA sequencing patterns in 1994. [1] They are ubiquitous in the environment but are infrequently isolated from clinical samples. B. vesicularis has been implicated in several cases; [2] however, B. diminuta infection has rarely been reported. Nowadays, few reports of invasive infections caused by B. diminuta exist in the literature in our country. Here we report on the patient with B. diminuta bacteremia and review the previously reported cases.

   Case Report Top

A 62-year-old male patient had repeated fatigue for 12 years, was admitted to our hospital on March 6, 2014. Previously, in 2011, the patient was diagnosed with myelodysplastic syndromes (MDS) and afflicted with drug-induced liver injury of oral cyclosporine treatment. Bone marrow aspiration revealed increased cellularity with multi-lineage dysplasia. Moderate erythroid dysplasia was present in the form of binucleation. Conventional cytogenetic studies showed a multiple abnormal karyotype (47XY, +8). In addition, he had a previous history of diabetes mellitus type 2 for 4 years and hepatitis B for several years.

The laboratory findings on a peripheral venous blood sample taken on admission were as follows: White blood cell (WBC) count, 0.7 × 10 9 cells/L; red blood cell (RBC) count, 2.02 × 10 12 cells/L; hemoglobin (HGB) count, 78 g/L; platelet (PLT) count, 3 × 10 9 cells/L; indicating the failure of bone marrow hematopoietic function. Furthermore, laboratory studies revealed abnormal liver function as follows: Aspartate aminotransferase (AST) 40 U/L; alanine transaminase (ALT) 86 U/L; indicating the drug injury of livers.

The blood cultures were taken when the patient was febrile (38.5°C). In the culture of blood specimen, there was a pure growth of Gram-negative rods. Colonies on blood agar were entire, convex, smooth, opaque and slightly yellowish. The organism was identified by Vitek 2 System (bioMerieux, France) GN Card as B. diminuta/B. vesicularis (with 94% accuracy).

Polymerase chain reaction (PCR) amplification of the 16S rRNA was performed in order to confirm the identification. A PCR product of the 16 rRNA gene, using the universal bacterial primers described by Han and Andrade, [3] was obtained by using EX Taq mix (TaKaRa). Sequencing of the 593 bp fragment product was performed with an ABI 3730XL sequencer (USA). The sequences were analyzed through a query to the GenBank BLAST. Sequence analysis revealed 99% identity with the sequences corresponding to the 16S rRNA gene of B. diminuta strain ATCC 11568.

The antibiotic susceptibility test was performed using the Vitek 2 System employing the AST-GN13 (Gram-negative susceptibility card) panel. The minimum inhibitory concentration breakpoints used to discriminate among susceptible, intermediate, and resistant categories were interpreted by using Clinical and Laboratory Standards Institute guidelines.  Escherichia More Details coli ATCC25922 and Pseudomonas aeruginosa ATCC27853 were used as quality control strains. The microorganism presented extensive drug susceptibility except aztreonam, tobramycin and ceftazidime [Table 1].
Table 1: Antibiotic susceptibilities of the Brevundimonas diminuta clinical isolate described in this report

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Two weeks after treatment, the blood cultures were negative, and the patient was discharged home without complications.

   Discussion Top

There are rare reports in the literature on infections caused by B. diminuta. We conducted a PubMed literature search limited to English-language publications using B. diminuta as a search term, and 15 cases were found. The demographic data and clinical characteristics of patients with B. diminuta infections are listed in [Table 2]. The organisms have been isolated from human blood samples, [3],[4],[5] as well as sputum, [6] urine, [3] empyema, [3] biopsy specimens, [7] corneal ulcer [8] and pleural fluid. [9] Most of the patients were immunocompromised because of hematologic malignancy such as leukemia and lymphoma. [3],[5] The factor predisposing patients to this infection remain unknown. Good outcomes were noted after appropriate therapy except one case. [7]
Table 2: Clinical features in past literature reporting Brevundimonas diminuta infection

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Here, we present a case of bacteremia caused by B. diminuta of a patient with MDS at a teaching hospital. MDS comprise a heterogeneous group of hematopoietic cell disorders characterized by cytopenias, bone marrow hypercellularity, and ineffective hematopoiesis. In our report, pancytopenia was presented by laboratory tests, which made the patient at an immunocompromised state. B. diminuta has been isolated from water, soil and plants, and, in fact, is used for the validation of membranes and filters in water treatment facilities. [10] Uncommonly, it has been described as opportunistic pathogens in immunocompromised hosts. Accordingly, bacteremia caused by B. diminuta in the patient with MDS was present. Although we considered whether it represented the true pathogen or not, contamination of our clinical samples by B. diminuta had never been observed.

Commonly, laboratory identification of B. diminuta is based on colony morphology in blood agar plate, Gram stain and biochemistry test. However, sometimes, the automatic system (Vitek 2) cannot distinguish between B. diminuta and B. vesicularis. Thus, in our report, the identification was confirmed ultimately by 16s rRNA sequencing method, which is a robust alternative method for the rapid identification of pathogens, especially those that are rare or difficult to identify by conventional method. Lee et al. [5] reported that 30 patients had B. bacteremia confirmed using the 16 s rRNA sequencing method, which was more specific than commercial method.

Although the literature, as well as our study, showed B. diminuta is capable of causing infections, it is generally nonfatal because of uniform susceptibility to piperacillin/tazobactam, aminoglycoside (Amikacine, Gentamicin) and carbapenems (Imipenem) as documented in previous studies. [3],[6],[7],[8],[9] In contrast, the commonly used fluoroquinolones and anti-pseudomonal cephalosporins are thought to have undesirable effects. [3] However, the antibiotic susceptibilities to fluoroquinolones and anti-pseudomonal cephalosporins in our report were conflicting to other studies and require further investigation. Furthermore, the optimal therapeutic duration for B. diminuta infections in various situations remains to be established.

   References Top

Segers P, Vancanneyt M, Pot B, Torck U, Hoste B, Dewettinck D, et al. Classification of Pseudomonas diminuta Leifson and Hugh 1954 and Pseudomonas vesicularis Büsing, Döll, and Freytag 1953 in Brevundimonas gen. nov. as Brevundimonas diminuta comb. nov. and Brevundimonas vesicularis comb. nov. respectively. Int J Syst Bacteriol 1994;44:499-510.  Back to cited text no. 1
Shang ST, Chiu SK, Chan MC, Wang NC, Yang YS, Lin JC, et al. Invasive Brevundimonas vesicularis bacteremia: Two case reports and review of the literature. J Microbiol Immunol Infect 2012;45:468-72.  Back to cited text no. 2
Han XY, Andrade RA. Brevundimonas diminuta infections and its resistance to fluoroquinolones. J Antimicrob Chemother 2005;55:853-9.  Back to cited text no. 3
Chi CY, Fung CP, Wong WW, Liu CY. Brevundimonas bacteremia: Two case reports and literature review. Scand J Infect Dis 2004;36:59-61.  Back to cited text no. 4
Lee MR, Huang YT, Liao CH, Chuang TY, Lin CK, Lee SW, et al. Bacteremia caused by Brevundimonas species at a tertiary care hospital in Taiwan, 2000-2010. Eur J Clin Microbiol Infect Dis 2011;30:1185-91.  Back to cited text no. 5
Menuet M, Bittar F, Stremler N, Dubus JC, Sarles J, Raoult D, et al. First isolation of two colistin-resistant emerging pathogens, Brevundimonas diminuta and Ochrobactrum anthropi, in a woman with cystic fibrosis: A case report. J Med Case Rep 2008;2:373.  Back to cited text no. 6
Almuzara MN, Barberis CM, Rodríguez CH, Famiglietti AM, Ramirez MS, Vay CA. First report of an extensively drug-resistant VIM-2 metallo-ß-lactamase-producing Brevundimonas diminuta clinical isolate. J Clin Microbiol 2012;50:2830-2.  Back to cited text no. 7
Pandit RT. Brevundimonas diminuta keratitis. Eye Contact Lens 2012;38:63-5.  Back to cited text no. 8
Lu B, Shi Y, Zhu F, Xu X. Pleuritis due to Brevundimonas diminuta in a previously healthy man. J Med Microbiol 2013;62:479-82.  Back to cited text no. 9
Donofrio RS, Bestervelt LL, Saha R, Bagley ST. Quantitative real-time PCR and fluorescence in situ hybridization approaches for enumerating Brevundimonas diminuta in drinking water. J Ind Microbiol Biotechnol 2010;37:909-18.  Back to cited text no. 10

Correspondence Address:
Dr. Huiling Cao
Department of Laboratory Medicine, Jiangsu Province Hospital of Traditional Chinese Medicine, 155 Hanzhong Road, 210029, Nanjing
P. R. China
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.162920

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  [Table 1], [Table 2]

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