Edit concept Question Editor Create issue ticket

Burkholderia Cepacia


Presentation

  • An 11-year-old male with a history of aplastic anemia presented to the emergency department with a 1-day history of cough and purulent nasal discharge 6 months after undergoing bone marrow transplant.[ncbi.nlm.nih.gov]
  • We describe an 11-year-old girl with cystic fibrosis (CF) who presented with respiratory failure and Burkholderia cepacia bacteremia (cepacia syndrome).[ncbi.nlm.nih.gov]
  • Abstract Hemophagocytic syndrome, splenic microabscesses and pulmonary cavitary lesions were presented in a 17-month-old boy with prolonged fever, hepatosplenomegaly and a history of tuberculous lymphadenitis. Clinical course mimicked tuberculosis.[ncbi.nlm.nih.gov]
  • A report of B cepacia bronchiectasis is presented where a previously healthy mother of two cystic fibrosis children colonised with B cepacia became infected by the same epidemic strain.[ncbi.nlm.nih.gov]
  • Clinical presentation was anemia of undetermined cause and weight loss. Three blood cultures were positive for Burkholderia cepacia.[ncbi.nlm.nih.gov]
Hunting
  • Hunt, S. Loutet, A. D. Vinion-Dubiel, A. Datta, B. Choudhury, J. B. Goldberg, R. Carlson, and M. A. Valvano. 2005.[doi.org]
  • Nature 410, 1099–1103 (2001). 102 Hunt, T. A., Kooi, C., Sokol, P. A. & Valvano, M. A. Identification of Burkholderia cenocepacia genes required for bacterial survival in vivo. Infect. Immun. 72, 4010–4022 (2004). 103 McMenamin, J. D., Zaccone, T.[doi.org]
Weight Loss
  • Clinical presentation was anemia of undetermined cause and weight loss. Three blood cultures were positive for Burkholderia cepacia.[ncbi.nlm.nih.gov]
  • Fever, an elevated white blood cell count, weight loss and an often fatal deterioration in pulmonary function characterize a particular clinical course, termed "Cepacia syndrome".[ncbi.nlm.nih.gov]
Aspiration
  • Aqueous aspirates, vitreous aspirates and environmental surveillance specimens were sampled.[ncbi.nlm.nih.gov]
  • Ultrasound-guided, percutaneous aspiration from splenic microabscesses grew Burkholderia cepacia. He was treated successfully with trimethoprim-sulfamethoxazole.[ncbi.nlm.nih.gov]
  • METHODS: During April 2012 the Infection Control Committee became concerned when B. cepacia was isolated from tracheal aspirate cultures of three ICU patients. The medical records for the years 2011 and 2012 were reviewed to identify further cases.[ncbi.nlm.nih.gov]
  • RESULTS: During June 1-14, 2015, 4 cases of ventilator-associated pneumonia (VAP) were identified; B cepacia was isolated from endotracheal aspirate samples.[ncbi.nlm.nih.gov]
  • The positive isolates were from tracheal aspirates and blood. After the identification, the patients were placed in contact isolation, as B cepacia can spread among susceptible individuals.[contagionlive.com]
Respiratory Distress
  • A female Indonesian newborn was referred to our neonatal intensive care unit because of respiratory distress. The newborn had been delivered the previous night via cesarean section.[ncbi.nlm.nih.gov]
  • Lethargy and respiratory distress (41.7 %) were major presenting features. Five newborns (41.7 %) required mechanical ventilation for 3-7 d.[ncbi.nlm.nih.gov]
  • In these patients, cepacia syndrome may present with fever, leukocytosis, pulmonary infiltrates, respiratory distress (necrotizing pneumonia), and septicemia.[ijciis.org]
Respiratory Disorders
  • The respiratory disorder classifications were as follows: obstructive-4.8% (Group-A) and 23.8% (Group-B); restrictive-9.5% (Group-A and Group-B); obstructive restrictive-19% (Group-A) and 1.6% (Group-B); and obstructive restrictive with a decreased forced[ncbi.nlm.nih.gov]
Hepatosplenomegaly
  • Abstract Hemophagocytic syndrome, splenic microabscesses and pulmonary cavitary lesions were presented in a 17-month-old boy with prolonged fever, hepatosplenomegaly and a history of tuberculous lymphadenitis. Clinical course mimicked tuberculosis.[ncbi.nlm.nih.gov]
Chemosis
  • At day 10, the pain relieved and the clinical condition of the patient improved with resolution of the purulent discharge, severe circumcorneal congestion and chemosis. The size of the corneal abscess and anterior chamber exudation decreased.[ncbi.nlm.nih.gov]
Redness of Eye
  • A man in his mid-70s with underlying poorly controlled diabetes mellitus came with complaints of painful red left eye for 4 days.[ncbi.nlm.nih.gov]
Photophobia
  • This was accompanied with photophobia and blurring of vision after being injured by a wooden particle while cutting grass. Slit-lamp examination showed a paracentral anterior corneal stromal infiltrates with overlying epithelial defect.[ncbi.nlm.nih.gov]
Withdrawn
  • The offending drug was immediately withdrawn from the NICU and the hospital pharmacy, and local authorities were informed. All seven babies were discharged with no infection-related morbidities. Copyright  2016 The Healthcare Infection Society.[ncbi.nlm.nih.gov]
  • The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases. CONCLUSIONS: This outbreak was thus linked to intrinsic contamination of medication vials.[ncbi.nlm.nih.gov]
  • After the CHG products were withdrawn, the outbreak was resolved. CONCLUSIONS: The pseudobacteraemia cases were caused by contaminated 0.5% CHG produced by a single manufacturer.[ncbi.nlm.nih.gov]
  • The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases. Conclusions: This outbreak was thus linked to intrinsic contamination of medication vials.[ijmm.org]
Cesarean Section
  • The newborn had been delivered the previous night via cesarean section. A physical examination revealed intercostal retractions and weak cry.[ncbi.nlm.nih.gov]
Lethargy
  • Lethargy and respiratory distress (41.7 %) were major presenting features. Five newborns (41.7 %) required mechanical ventilation for 3-7 d.[ncbi.nlm.nih.gov]

Workup

  • In addition, given the rarity with which B. cepacia is identified as a cause of pneumonia in the immunocompetent host, isolation of B. cepacia should trigger a workup for underlying immunodeficiency or lead to an investigation to exclude the possibility[ncbi.nlm.nih.gov]
  • Initial laboratory workup at admission showed improving thrombocytopenia and liver function tests. Workup for tropical infections revealed positive dengue IgM and positive scrub typhus serology. Procalcitonin was elevated at 6.5 ng/ml.[ijciis.org]
Cavitary Lesion
  • Abstract Hemophagocytic syndrome, splenic microabscesses and pulmonary cavitary lesions were presented in a 17-month-old boy with prolonged fever, hepatosplenomegaly and a history of tuberculous lymphadenitis. Clinical course mimicked tuberculosis.[ncbi.nlm.nih.gov]

Treatment

  • Bronchoalveolar lavage samples taken during flexible bronchoscopy were used prior to treatment to exclude spontaneous clearance as well as after treatment to confirm eradication.[ncbi.nlm.nih.gov]
  • OBJECTIVES: To identify whether treatment of Burkholderia cepacia complex infections can achieve eradication, or if treatment can prevent or delay the onset of chronic infection.[ncbi.nlm.nih.gov]
  • […] to another antibiotic, placebo or no treatment.[ncbi.nlm.nih.gov]
  • Fifteen patients (68.2%) responded to medical treatment while 7 (31.8%) required catheter removal.[ncbi.nlm.nih.gov]
  • Her ulcer became worse after treatment with tobramycin and gentamicin for 1 day. After treatment with ciprofloxacin, the ulcer healed, and visual acuity returned to 20/20 with spectacle correction.[ncbi.nlm.nih.gov]

Prognosis

  • Burkholderia cepacia is a gram-negative bacilli leading to pneumonia with poor prognosis and usually seen in patients with immunosuppression or with structural lung diseases.[ncbi.nlm.nih.gov]
  • These bacteria are important opportunistic pathogens, especially in cystic fibrosis (CF) patients, and are associated with a worse prognosis and decreased life expectancy.[ncbi.nlm.nih.gov]
  • Patients with Bcc infection have a poorer outcome (Meachery et al , 2008) and B. cenocepacia is now a contra-indication to lung transplantation as it is associated with such poor prognosis and post transplant sepsis.[cfmedicine.com]
  • […] for patients with cystic fibrosis (CF), sometimes resulting in accelerated pulmonary deterioration, with fatal necrotising pneumonia and bacteraemia. 3 Because of its high transmissibility, multiple antibiotic resistance, and association with a poor prognosis[jcp.bmj.com]
  • The marked difference in prognosis among infected patients has not been adequately explained but is thought to result in part from differences among infecting strains of B. cepacia complex.[ncbi.nlm.nih.gov]

Etiology

  • CONCLUSIONS: B. cepacia may be an etiologic agent of severe hospital acquired pneumonia and sepsis among immunocompromised patients. Clinically infection develops picture of superinfection and usually is life-threatening condition.[ncbi.nlm.nih.gov]
  • The etiology of the infections reflected these clinical factors: Most (62%) were nosocomial, with 41% associated with a central venous line and 20% with pneumonia.[mdedge.com]
  • Burkholder, American bacteriologist who discovered the etiological agent of onion rot. Valid publication: Validation List no. 45. Int. J. Syst. Bacteriol., 1993, 43, 398-399.[bacterio.net]

Epidemiology

  • Sound epidemiological methods are very important for identifying the source of any hospital infection outbreak. Copyright 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.[ncbi.nlm.nih.gov]
  • Based on microbiological and epidemiological data and molecular typing by pulsed-field gel electrophoresis, we report the occurrence of two outbreaks of R. pickettii and B. cepacia complex bloodstream infections.[ncbi.nlm.nih.gov]
  • Copyright 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.[ncbi.nlm.nih.gov]
  • The authors aimed to determine epidemiology, clinical features, antibiotic sensitivity pattern, complications and outcome of blood culture proven B. cepacia infections in 12 neonates. All neonates were outborn, 5 preterm and 7 term.[ncbi.nlm.nih.gov]
  • INTRODUCTION: The epidemiology of Burkholderia cepacia complex (Bcc) in cystic fibrosis (CF) is not widely known. METHODS: All CF patients with Bcc between 2002 and 2011 were reviewed, and a molecular analysis of isolates was performed.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology of B cepacia infection mirrors that of other nonfermentative aerobic gram-negative bacilli.[emedicine.medscape.com]
  • Gibson RL, Burns JL, Ramsey BW (2003) Pathophysiology and management of pulmonary infections in cystic fibrosis. Am J Respir Crit Care Med 168: 918-951. 7.[trivediscience.com]
  • Pathophysiology and management of pulmonary infections in cystic fibrosis. Am. J. Respir. Crit. Care Med. 168, 918–951 (2003). 35 Duff, A. J.[doi.org]

Prevention

  • Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Routine cleaning and disinfection of ventilators, in addition to an intervention bundle, should form part of an integrated VAP prevention and management approach.[ncbi.nlm.nih.gov]
  • Defining species by means of molecular analysis yields important information for the clinician in order to establish the most appropriate therapy and implement correct measures for prevention of transmission among CF subjects.[ncbi.nlm.nih.gov]
  • Stricter government regulation is needed to prevent contamination of disinfectants during manufacturing.[ncbi.nlm.nih.gov]
  • The vaccine now routinely used in children to prevent whooping cough contains five molecules that Pertussis uses to attach to the throat.[cfireland.ie]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!