CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector Concise Communications 109 Tuberculosis should be considered when broad- coccobacillus, Roseomonas gilardii, in an immuno- spectrum antibiotherapy is ineffective and no evident compromised patient and we also review the literature cause is found for urinary infection following ECL. in order to delineate the epidemiology and pathogenic role of Roseomonas spp. isolated from blood samples. A. Chaumeron ', J. Peceny I, 0. Rauzy2, L. Cuzin', Case report B. Marchou I, J. Ch. Auvergnat ' A 59-year-old man with M1-type acute myelogenous 'Department of Infectious Diseases leukemia developed fever (39°C) while on chemo- (Pr Auvergnat), Purpan Hospital, therapy, 4 months after the implantation of a Hickman Toulouse, France; catheter. One out of the four blood cultures obtained 21nternal Medecine (Pr Carles), through a peripheral vein grew pink-pigmented bacteria Purpan Hospital, and the patient was afebrile when discharged after 10 Toulouse, France days of intravenous imipenem and tobramycin followed by oral ciprofloxacin for 5 days. The patient was re- Revised version accepted 16 August 1997 admitted 2 weeks later with a new febrile episode (39"C), and a similar microorganism was isolated in References two out of three blood cultures. The patient defervesced 1. Federmann M, Kley HK. Mhary tuberculosis after extra- with intravenous ceftazidime for 13 days followed by corporeal shock-wave lithotripsy. N Engl J Med 1990; 323: oral ciprofloxacin for 10 days and was discharged. 1212. A third episode occurred 2 weeks after the second 2. Morano Amado LE, Amador Barciela L, Fernandez AR, discharge. Lysis-centrifugation blood cultures obtained Sapina Llamas IM, Vazquez Alvarez 0, Fernandez Martin J. Extracorporeal shock-wave lithotripsy complicated with through both catheter lumens showed colonies too darytuberculosis. J Urol 1993; 149: 1532-4. numerous to count. A simultaneous peripheral blood 3. Coptcoat MJ, Webb DR, Kellett MJ, et al. The complica- sample treated with lysis-centrifugation showed no tions of extracorporeal shock-wave lithotripsy: management growth. The Hickman catheter was removed after 10 and prevention. Br J Urol 1986; 58: 578-80. days but unfortunately the tip was not sent for culture. 4. Lenk J, Schubert G, Oesterwitz H, Brien G. Urolithiasis The patient was discharged with oral ciprofloxacin and associated with urogenital tuberculosis: clinical and micro- cloxacillin for 7 days. Five months later he has not had biological aspects. Urol Res 1988; 16: 157-9. further episodes of bacteremia. All pink-pigmented 5. Ahuja SS, Ahuja SK, Phelps KR, Thelmo W, Hill R. bacteria grown from blood cultures of the three Hernodynamic confirmation of septic shock in disseminated episodes of bacteremia were identified as Roseomonas tuberculosis. Crit Care Med 1992; 6(20): 901-3. 6. George S, Papa L, Sheds L, Magnussen CR. Septic shock gilardii. due to disseminated tuberculosis. Clin Infect Dis 1996; 22: In all cases, pink-pigmented colonies grew after 48 188-9 h of incubation at 37°C on Columbia blood agar plates. 7. Godwin JE, Coleman AA, Sahn SA. Miliary tuberculosis The Gram stain revealed Gram-negative, non-vacuo- presenting as hepatic and renal failure. Chest 1991; 99: 752- lated coccoid rods, arranged in pairs. The organism 4. grew on MacConkey agar and weakly on Columbia 8. Hussain W, Mutimer D, Harrison R, Hubscher S, Neuberger blood agar at 42°C. Catalase and oxidase tests were J. Fulmiiiant hepatic failure caused by tuberculosis. Gut positive, although the latter test was delayed for 30 s. 1995; 36: 792-4. The organism was non-fermentative on triple sugar 9. Lefering R, Neubauer EA. Steroid controversy in sepsis iron agar, and the API 20NE identification system and septic shock: a metaanalysis. Crit Care Med 1995; 23: (BioMtrieux, Marcy L'Etoile, France) gave positive 1294-303. results for urease production, and oxidation of glucose, arabinose, malate and citrate, while nitrate reduction, glucose fermentation, indole production, arginine di- hydrolase, p-glucosidase (esculinase), gelatinase and p- Bacteremia due to Roseomonas spp. galactosidase tests and oxidation of mannose, mannitol, N-acetylglucosamine, maltose, gluconate, caprate, adi- Clin Microbiol Infect 1998; 4: 109-1 12 pate and phenylacetate were negative (code number Pink-pigmented, oxidative Gram-negative bacteria have 0241045). The API computer database identified the occasionally been isolated from various clinical samples microorganism as Pseudomonas mesophilica, and citrate [l]. However, their clinical significance is still fre- oxidation was the only unacceptable test. Because this quently debated [2]. We report a case of catheter- database does not include the genus Roseomonas, further related bacteremia due to a pink Gram-negative tests were performed to confirm the identification. 110 Clinical Microbiology and Infection, Volume 4 Number 2, February 1998 Fatty acid analysis was pedonned by gas-liquid chronia- (54mg/mL), aztreoiiam (18 mg/niL) and imiperlenl tography as described previously [I ], and identification (54 mg/mL), and they were resistant to cefuroxime of the fatty acid methyl esters was confirmed by (> 16 mg/mL), cefotaxinie (>32 mg/mL), ceftazidinie computer-calculated equivalent carbon-chain-length (> 16 mg/mL) and triInethoprini/sulfaniethoxazole values. The cellular fatty acid composition of the strains (>2/32 mg/mL). No increase in the MICs was observed ~vasidentical to that of previously described pink in the susceptibility patterns of the three isolates after coccoid groups I, I1 and 111, revealing the presence antimicrobial therapy. of ~-OH-CI~(~,CIX:IH. Z-OW-C~X-I, C~~:,III 11,12 and In the MEDLINE index from January 197U to ~-OH-CI~,O~,II,I~,all absent in ,~etlzy(abucteviirm December 1996 we were able to find 10 5atisfactorily riterophilici.rm, and the absence of 3-0H-Cl~0 (present documented cases (1 1 including ours) of Roscor?zorzus in this species of Metliylobartericrnz) [ 11. These data, spp. bacteremia, and these are summarized in Table I. together with the lack of both acetate utilization and Nine cases involved adults and two involved children acid production from methanol, confirmed that our (a previously healthy 9-month-old boy with epiglottitis isolates belonged to the genus Roseamo~as.According and a 15-year-old girl with acute lymphocytic leukemia), to the biochemical characteristics obtained with the median age was 56 years (ranging between 9 the API 20NE system and oxidation of glycerol, the months and 73 years) [2,3].Six patients were female microorganisms were identified as Roseomoms gilardii. and five were male. In nine cases the patients presented All isolates in our case were susceptible to with an underlying disease (eight were inirnuno- ampicillin (50.5mg/InL), amoxicillin/clavulanic acid compromised patients): four of them presented with (S2/1 mg/mL). cefazolin (~4mg/mL), gentamicin acute leukemia [2,4,3], one was diagnosed with cancer, (51 ing/niL), tobramycin (51 mg/mL), amikacin one was diagnosed with Crohn's disease IS], one pre- (54 mg/mL), ciprofloxacin ( s 1 mg/mL), tetracycline sented with end-stage renal disease in hernodialysis [6], Table 1 C:limcal characteristics of .patients with Ros~oitiunasspp. bacterernia Underlying Clinical rhcunlemd Anhrnicrobidl Outcollle Yfx/I<ef Chintry Age/scx condition characteristicr infkction therapy (ddyr) Nigsria (11 None Fryer, cpiglottitir 13loorl Ampicillin Curcd USA 19/F Breast cancer Fcvrr, chills BloOd'.r No datd Cured UFA 62/€ Crohn's disease Fc\er, chills Blood' i. Nct data Curd U5A 57/F AML Fever. chills Blood' No data Cured USA 1O/F AML Fcver. chills nioodd Piperacrllin, Curd gentamicin us.4 6WM Iiitra-abdoiiunal Fexer, schock Blood' Cefatiiandole Ilcath (+3) abscesw USA 56/M End-stage renal Shock, naucea, Hlood" i. Vanconiycin, L)eath (f 1) disease in voiiiiting dyspnea gcntaiiiicirr hemodi alysis USA 73/F Diabetes mellitu, F~bei-,bronchitis Blood USA 36/M None Fever Ulood USA 15/F ALL Fever blood^' Spdlil 59/M AML Fevcr. Threc Blood' irldpsiiia rpi<odec .'Nine iiionthc I' AML, aCute iiiyclogriious leukeinia; ALL, acute lymphocytic lcukeiir1.i ' Blood cultures obtained through an mdwelling vascular catheter. <:atheter-related bactcrenila. "Purportedly catheter-related bactereinia. ' Norocoiiiially acquired bacterernia. I IMI! innpenern; TOB, tobmmycin: C:IP, ciprofloxacin; CAZ, ceftazidime: TEI, tcicoplanin; VA, vdncoinycui: OX, oxacillin Concise Communications 111 one was habetic [2] and one without immunosup- tetracycline) were susceptible to imipenem, amino- pression had a pancreatic abscess [4]. The two cases glycosides and tetracycline. In our case, despite the without underlying disease were a 9-month-old boy three consecutive courses of adequate antimicrobial with epiglottitis and a previously healthy patient [2]. agents, bacteremia recurred until the catheter was Eight cases were nosocomially acquired. Four of them removed. Unfortunately, there is no information about were diagnosed as catheter-related bacteremias, another what happened with the catheters in seven catheter- three were purportedly catheter-related, and no infor- related bacteremias caused by Roseomonas spp. reported mation was available for one. Among the 11 cases, nine in the literature. had a favorable outcome and two patients developed Pink coccoid oxidase-positive microorganisms septic shock and died before the blood cultures became should not be simply disregarded as contaminants.