Case Report
 

By Dr. Shobha KL , Dr. Ramachandra L , Gowrish S , Nagalakshmi N
Corresponding Author Dr. Shobha KL
Department of Microbiology , Melaka Manipal Medical College (Manipal Campus ), Melaka Manipal Medical College , Manipal Campus , Manipal,Karnataka State - India 576104
Submitting Author Dr. Shobha KL
Other Authors Dr. Ramachandra L
Department of Surgery,Kasturba Medical College,Manipal University,Manipal, Department of SurgerynKasturba Medical College nManipal University,ManipalnUdupi Dist,Karnataka State - India

Gowrish S
Department of Microbiology,Melaka Manipal Medical College(Manipal Campus),Manipal University,Manipal, Melaka Manipal Medical College(Manipal Campus)nManipal University,ManipalnUdupi Dist,Karnataka State - India 576104

Nagalakshmi N
Department of Microbiology,Melaka Manipal Medical College(Manipal Campus),Manipal University,Manipal, Department of MicrobiologynMelaka Manipal Medical College(Manipal Campus)nManipal University,ManipalnUdupi Dist,Karnataka State - India 576104

MICROBIOLOGY

B.diminuta, ciprofloxacin resistant

KL S, L R, S G, N N. Brevundimonas diminuta causing urinary tract infection. WebmedCentral MICROBIOLOGY 2013;4(9):WMC004411
doi: 10.9754/journal.wmc.2013.004411

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
No
Submitted on: 28 Sep 2013 12:45:24 PM GMT
Published on: 30 Sep 2013 06:06:35 AM GMT

Abstract


Objectives: To report urinary tract infection caused by Brevundimonas diminuta and antibiotic susceptibility pattern of this gram negative bacillus.

Patient and methods: Urine from an infant suffering from fever and vomiting suspected of urinary tract infection was analyzed .His blood was also collected for cell count. Isolation and identification of the organism was done from urine sample, followed by antibiotic susceptibility testing of the organism isolated.

Results: Brevundimonas diminuta was isolated from urine specimen. Strain was sensitive to amikacin, imipenem,ticarcillin/clavunalic acid but resistant to ampicillin and ciprofloxacin.

Conclusion: B.diminuta  is a rare pathogen and can cause urinary tract  infection. The organism is resistant to quinolones and this should be opted out for treatment.

Key words: B.diminuta, ciprofloxacin resistant

Introduction


Brevundimonas diminuta is a non-lactose-fermenting environmental Gram-negative bacillus previously assigned to the genus Pseudomonas.1-3.

These organisms are infrequently isolated in clinical microbiology laboratories 4.B.diminuta infection has not been reported from our laboratory. Here we report a case of Brevundimonas diminuta causing urinary tract infection in an infant with its antimicrobial susceptibility pattern .

Patient and Methods


A nine month old infant was brought to hospital with history of fever and vomiting. On examination his temperature was 39°C. Respiratory and Cardiovascular systems were normal. Blood and urine samples were collected and was sent to laboratory for investigations. Blood tests included hemoglobin estimation, total and differential count. Urine sample was processed for presence of nitrate, protein, bacteria, pus-cells and estimation of specific gravity. Gram’s staining was performed on the urine sample. Urine was inoculated on blood agar, MacConkey’s agar and CLED medium using a standard loop of internal diameter of 2mm. Semiquantitative technique of Kass concept for significant bacteriuria was followed5. Identification of the organism was done by conventional methods6 and confirmed by Vitex (Biomerex). Antibiotic sensitivity testing was done by Kirby-Bauer disc diffusion method as per the CLSI guidelines7.

Results


Patients hemoglobin was 9.3g/dl, platelet count 293.0x103/µl, WBC 35.6x103/ µ u, MCV 75.4fl,MCH 25.3pg,MCHC 33.5g/dl, Monocytes 11.6%,Eosonophil 0.1%, Basophil 0.1%. Urine nitrate was positive, protein 2+,pH 6, Specific gravity 1.020, WBC numerous, RBC 20-25/ hpf Epithelial cells 2-3 /hpf. Gram’s stain showed gram negative bacilli with plenty of pus cells.Urine sample was further processed for identification and antibacterial susceptible testing. Growth by semiquantitative Kass method showed 105 colony forming units on blood agar. Non lactose fermenting colonies were seen in MacConkey agar. It was identified as Brevundimonas diminuta and the strain was susceptible to Amikacin 30µg,Amoxicillin-Clavulanic acid20/10 µg, cefotaxime30µg, trimethoprim / sulfamethoxazole 1.25/23.75 µg, Ticarcillin/clavulanic acid 75/10 µg, cefepime 30µg, imipenem 10 µg. Strain was resistant to ciprofloxacin 5 µg. Patient was treated with Ticarcillin/clavulanic acid. Repeat urine sample after three weeks did not yield any bacterial growth on the culture media.

Discussion


Brevundimonas diminuta is a gram negative bacillus which is a nonfermenter, oxidase and catalase positive and not forming indole1.It was previously assigned to genus Pseudomonas .The numerical analyses of whole-cell protein patterns, fatty acid compositions, phenotypic characteristics, DNA base ratios showed it to  be categorized in a separate genus 3 . Xang yang et al 8 in their study had a case of urinary tract infection infected with Brevundimonas diminuta and  was resistant to quinolones .Our study also showed  similar results, the strain was resistant to ciprofloxacin .

Conclusion


Brevundimonas is a rare opportunistic pathogen causing urinary tract infection, The organism is resistant to quinolones and this should be opted out for treatment. Adequate antimicrobial agents are still warranted in most of the patients due to infections with this organism.

References


1.Gilligan PH,Lum G, Vandamme PAR, et al. Burkholderia Stenotrophomonas Ralstonia, Brevundimonas, Comamonas, Delftia, Pandoraea and Acidovarax.(ed.Murray PR, Baron EJ,Jorgensen JH,et al), Manual of clinical Microbiology, 8th den.Washington,DC,USA;ASM Press, 2003: 729 – 748.
2.LefsonE,Hugh R.A new type of polar monotrichous flagellation :J Gen Microbiol:1954:10:68 – 70.
3. Segers P,Vancanneyt M,Pot B et al.Classification of Pseudomonas diminuta Leifson and Hugh 1954 and Pseudomonas vesicularis: Busing, Doll and Freytag 1953 in Brevundimonas  gen.nov as Brevundimonas diminuta Comb nov and Bervundimonas vesicularis comb.nov respectively.Int J Syst Bacteriol 1994: 44:499-510.
4. Hall G.Non-fermentative Gram-negative bacilli and miscellaneous gram-negative rods.In:Mahon C,Manuselis G,eds.Textbook of Diagnostic Microbiology. Philadelphia, PA,USA:W.B.Saunders company, 2000:539-563.
5.Kass EH.Asymptomatic infections of the urinary tract.Trans Assoc Am Phys.1956:69:56 – 63.
6. Ballard RW,Doudoroff M, Stanier RY,Mandel M (1968), Taxonomy of the aerobic Pseudomonadas, Pseudomonas diminuta And P.vesiculare.J Gen Microbiol:53 :349-361
7. Clinical Laboratory and Standard Institute (2010).Performance standards for antimicrobial susceptibility testing.20th informational supplement .CLSI document M100 –S20.
8.Xiang Y Han,Roberto A Andrade: Brevundimonas diminuta infections and its resistance to fluoroquinolones.J Antimicrrob Chemother:2005 Jun :55(6):853 – 569.

Source(s) of Funding


Manipal University,Manipal

Competing Interests


Nil

Reviews
2 reviews posted so far

Comments on Brevundimonas diminuta causing urinary tract infection
Posted by Dr. D.G. Naik on 01 Dec 2013 02:28:54 AM GMT Reviewed by Interested Peers

A case of Urinary tract infection with Brevundimonas diminuta
Posted by Dr. Venkataramana Kandi on 01 Oct 2013 03:45:08 PM GMT Reviewed by WMC Editors

Comments
0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.

 

Author Comments
0 comments posted so far

 

What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
Where
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)