ELIZABETHKIN
GIA
MENINGOSEPTICA
Dr.T.V.Rao MD
4/6/16
Dr.T.V.Rao MD
Elizabethkingia
meningoseptica
Elizabethkingia
meningoseptica is a
gram-negative rodshaped bacterium
widely distributed in
nature (e.g. fresh
water, salt water, or
soil). It may be
normally present in
fish and frogs but is
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Dr.T.V.Rao MD
History of Elizabethkingia
In
1959, the
American
bacteriologist
Elizabeth O. King
(who isolated
Kingella in 1960)
was studying
unclassified
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Dr.T.V.Rao MD
Important Bacteria stable
and adopts to Environment
Elizabethkingia
meningoseptica has
been deemed a
potentially important
threat to patients in
critical care areas
because of its
multidrug-resistant
phenotype and its
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Dr.T.V.Rao MD
Elizabethkingia is found in the
environment
Commonly
found in
the environment,
particularly in soil
and water,
Elizabethkingia rarely
causes disease in
otherwise healthy
individuals.
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Dr.T.V.Rao MD
Uncommon pathogen and
Respiratory colonizer
Elizabethkingia
are
bacteria that are
rarely reported to
cause illness in
humans, and are
uncommon
colonizers of the
respiratory tract
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Dr.T.V.Rao MD
Present outbreak
In
this outbreak, the
bacteria primarily
infect older adults
and those who have
serious underlying
health conditions.
The infection typically
presents as
septicaemia and can
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Dr.T.V.Rao MD
E.
General Characteristics
E.
meningoseptica
meningoseptica
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is a species of
Gram-negative,
obligate
aerobic, nonfastidious, nonspore forming,
nonfermentative
; nonmotile;
slender; slightly
Dr.T.V.Rao MD
Elizabethkingia
Elizabethkingia
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is a genus of
bacteria
commonly found
in the
environment
worldwide and
has been
detected in soil,
river water and
Dr.T.V.Rao MD
Elizabethkingia meningoseptica on (a)
sheep blood agar and (b) MacConkey
agar
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Magnified view of the
Colonies ofElizabethkingia
anophelis
Three individual
Elizabethkingia
anophelis colonies
growing next to
each other on
blood agar. Photo
courtesy CDC
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Biochemically reacting
Catalase
positive, oxidase
positive, and indole-positive,
OF glucose ox+/F-, urease
negative (contrast E.
miricola which is urease
positive), mannitol positive,
non-nitrate-reducing
saprophytic bacilli. It is
gelatinase, esculin, ONPG &
DNAse positive.
Chryseobacteria
(Flavobacteria)
are in
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Dr.T.V.Rao MD
general indole positive in
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meningoseptica
Growth Characters
grows well in regular
E.
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incubators on blood
agar and chocolate
agar. Colonies are
very pale yellow and
may not be easily
evident at 24 hours.
E. meningoseptica
strains either are not
pigmented or
produce a weak
Dr.T.V.Rao MD
yellow nondiffusible 13
Infection
E.
meningoseptica
predominantly
causes outbreaks of
meningitis in
premature newborns and infants in
neonatal intensive
care units of
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Transmission and
Sources of the Infection
Neonatal
infections due
to C. meningosepticum
could be through vertical
transmission; however, no
data about this kind of
transmission of the
organism is available. As
many interventions
(endotracheal intubation,
central
and
peripheral
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Dr.T.V.Rao MD
intravascular
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Can be a nosocomial
Infection
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Majority of the C.
meningosepticum
infections reported
have been in NICUs,
the infections of
these neonates are
often considered as
nosocomial
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Some
Infection
of the outbreaks have been
linked to sources like contaminated
lipid stock bottles, contaminated
venous catheter lines and nutritional
solution, and tap water. The
bacterium is also a rare cause of
nosocomial pneumonia, endocarditis,
postoperative bacteremia, and
meningitis in immunocompromised
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Infection
Only
recently has
it also been
found to cause
soft tissue
infection and
sepsis in the
immunocompeten
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Current methods to identify
State
clinical microbiology laboratories
can characterize the isolates using
pulsed-field gel electrophoresis, a
method that can identify the
Elizabethkingia genus correctly. Isolates
sent to CDC's Special Bacteriology
Reference Laboratory are confirmed as
the species E anophelis on the basis of
the pathogen's protein profile, acquired
using the mass spectrometry method
MALDI-ToF (matrix-assisted laser
desorption/ionization time-of-flight),
and optical mapping of the bacterial
genome.
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Treatment and Drug resistant
patterns
This bacterium is usually
multiresistant to
antibiotics typically
prescribed for treating
gram-negative bacterial
infections, including
extended-spectrum betalactam agents (due to
production by most strains
of two beta lactamases:
one ESBL and one Class B
Carbapenem-Hydrolyzing
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Dr.T.V.Rao MD
metallolactamase),
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6 day old Blood agar growth of
Elizabethkingia meningioseptica
6
day old Blood agar growth of
Elizabethkingia meningioseptica
with 5ug vancomycin (with a
zone of clearing) and 10 ug
colistin disks. This strain did not
produce the flexirubin pigment.
Like Burkholderia cepacia this
organism can be Colistin
resistant and partially
Vancomycin sensitive
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A copy of the license is included in the section entitled GNU Free
Documentation License.
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Choosing the Antibiotics
Though
vancomycin
has been used in the
past, its high MIC (16
g/ml) has led to a
search for
alternatives,
especially for
meningitis. Presently
ciprofloxacin,
minocycline,
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Hypoalbumine
Predictors of poor
outcome
mia, increased
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pulse rate at
the onset of
infection, and
central venous
line infection
were
associated
with a poor
Dr.T.V.Rao MD
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CDC
Trends in management of
outbreaks
and the affected
states continue to work
toward managing the
ongoing outbreak. The
unexpected number of
infections with this
unusual pathogen
reminds us of the
importance of new and
emerging technologies,
such
4/6/16 as advanced
molecular detection and
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Infection Control Interventions
Outbreaks
of Gram-negative
bacterial infections are usually
due to transient carriage of
the organisms on the hands of
healthcare workers .
Susceptible patients may
become colonized after
acquiring the organism from
the healthcare worker, and
infection may or may not
develop.
Hand
washing by Health care workers
potentially stops spread
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The Medical Profession Need
more awareness on the
emerging
infection
In addition to reinforcement of standard
infection control measures, actions that
have successfully terminated E.
meningoseptica outbreaks include preemptive contact isolation, systematic
investigations to identify the source of the
bacterium and thorough cleaning of
equipment and environmental surfaces. As
the clinical complexity and incidence of E.
meningoseptica infections increase, there
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Resources and References
CDC
on Elizabethkingia
Medscape
Infectious diseases
WIKIPEDIA
ON LINE RESOURCE
Review Article Elizabethkingia meningosepticum
(Chryseobacterium meningosepticum) Infections in
Children Mehmet Ceyhan and Melda Celik
International Journal of Pediatrics Volume 2011
(2011), Article ID 215237, 7 pages
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Program
Created by Dr.T.V.Rao MD for
Medical and Paramedical Professionals
for awareness on the emerging trends
on Elizabethkingia meningoseptica
Email
[email protected]
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