Journal of Global Infectious DiseasesOfficial Publishing of International Infectiologists Network Users online:33  
Print this pageEmail this pageSmall font sizeDefault font sizeIncrease font size     
Home About us Editors Ahead of Print Current Issue Archives Search Instructions Subscribe Advertise Login 
 


 
   Table of Contents     
LETTER TO EDITOR  
Year : 2017  |  Volume : 9  |  Issue : 1  |  Page : 36-37
Achromobacter xylosoxidans septic arthritis in a child with primary immunodeficiency


1 Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
2 Department of Microbiology, Chacha Nehru Bal Chikitsalaya, New Delhi, India

Click here for correspondence address and email

Date of Web Publication13-Feb-2017
 

How to cite this article:
Singh A, Hussain A, Jain R, Aishwarya K, Tak V, Thakur P. Achromobacter xylosoxidans septic arthritis in a child with primary immunodeficiency. J Global Infect Dis 2017;9:36-7

How to cite this URL:
Singh A, Hussain A, Jain R, Aishwarya K, Tak V, Thakur P. Achromobacter xylosoxidans septic arthritis in a child with primary immunodeficiency. J Global Infect Dis [serial online] 2017 [cited 2017 Mar 22];9:36-7. Available from: http://www.jgid.org/text.asp?2017/9/1/36/192968


Sir,

Achromobacter is a Gram-negative aerobic bacilli known to cause opportunistic infections in neonates and patients with HIV infection,[1] cancer,[2] cystic fibrosis,[3] and hyper-immunoglobulin M [4] syndrome. We report a case of Achromobacter xylosoxidans sepsis with septic arthritis in a child with suspected severe combined immunodeficiency (SCID).

A 2-year and 11-month-old male child presented with complaints of high-grade fever with swelling and restriction of movement of bilateral knee joints for 10 days. There was a history of multiple respiratory infections starting at 1 year of age, including an episode of empyema thoracis. Initial investigations revealed total leukocyte count 28,360 cells/mm 3, neutrophil 65%, lymphocyte 25%, monocyte 7%, eosinophils 3% (absolute neutrophil count = 18,434/mm 3 and absolute lymphocyte count = 7090/mm 3), and C-reactive protein 290 mg/dl. Bilateral knee aspirates revealed acute inflammatory exudate. The child was empirically started on injection ceftriaxone and cloxacillin; however, there was no response in 72 h.

On day 4, his initial blood culture and knee aspirates showed growth of A. xylosoxidans. All the isolates were sensitive to ceftazidime, ciprofloxacin, and levofloxacin and resistant to gentamicin, amikacin, ceftriaxone, and cotrimoxazole. The antibiotic was changed to ceftazidime. Patient's joint symptoms improved and he became afebrile within 7 days of starting ceftazidime, which was continued for 6 weeks.

In view of a history of recurrent respiratory infection and disseminated infection with an opportunistic pathogen, possibility of immunodeficiency was considered. HIV serology was negative. His immune globulin profile showed severe panhypogammaglobulinemia and lymphocyte subset study was suggestive of T NK B + SCID [Table 1]. Intravenous immunoglobulin was given as a replacement therapy for panhypogammaglobulinemia. The child was advised monthly intravenous immunoglobulin replacement therapy and cotrimoxazole prophylaxis. He was referred for genetic testing and stem cell transplant. Mother was advised carrier testing for genetic counseling to explain the risk in future pregnancy.
Table 1: Immunoglobulin Profile and Lymphocyte Subset Analysis of the Patient

Click here to view


A. xylosoxidans infections are more common in immunocompromised hosts with indwelling catheters, endotracheal tubes, or other medical devices. It may disseminate and cause sepsis, meningitis, and death. It is a very rare cause of septic arthritis. A. xylosoxidans is found in water sources, and well water is considered to be the source of community-acquired infections and intravenous fluid, ventilator, or dialysis fluid in nosocomial infection. It is usually multiresistant to antimicrobial therapy.

SCID is most severe form of primary immune deficiency with a presentation in early infancy with recurrent infections and failure to thrive. Atypical or milder expression of SCID with genetic defects known to be associated with classical disease is reported.[5] Maternal T-cell engraftment is considered as a possible explanation for such atypical presentation.

To conclude, A. xylosoxidans is an emerging opportunistic pathogen. Although recurrent infections are common in children in developing countries, diagnosis of primary immunodeficiency should be considered in presence of severe, unusual, prolonged, or recurrent infections.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Manfredi R, Nanetti A, Ferri M, Chiodo F. Bacteremia and respiratory involvement by Alcaligenes xylosoxidans in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis 1997;16:933-8.  Back to cited text no. 1
    
2.
Tugcu D, Turel O, Aydogan G, Akcay A, Salcioglu Z, Akici F, et al. Successful treatment of multiresistant Achromobacter xylosoxidans bacteremia in a child with acute myeloid leukemia. Ann Saudi Med 2015;35:168-9.  Back to cited text no. 2
    
3.
Dunne WM Jr., Maisch S. Epidemiological investigation of infections due to Alcaligenes species in children and patients with cystic fibrosis: Use of repetitive-element-sequence polymerase chain reaction. Clin Infect Dis 1995;20:836-41.  Back to cited text no. 3
    
4.
Weitkamp JH, Tang YW, Haas DW, Midha NK, Crowe JE Jr. Recurrent Achromobacter xylosoxidans bacteremia associated with persistent lymph node infection in a patient with hyper-immunoglobulin M syndrome. Clin Infect Dis 2000;31:1183-7.  Back to cited text no. 4
    
5.
Frucht DM, Gadina M, Jagadeesh GJ, Aksentijevich I, Takada K, Bleesing JJ, et al. Unexpected and variable phenotypes in a family with JAK3 deficiency. Genes Immun 2001;2:422-32.  Back to cited text no. 5
    

Top
Correspondence Address:
Amitabh Singh
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-777X.192968

Rights and Permissions



 
 
    Tables

  [Table 1]



 

Top
  
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References
    Article Tables

 Article Access Statistics
    Viewed154    
    Printed2    
    Emailed0    
    PDF Downloaded0    
    Comments [Add]    

Recommend this journal

Sitemap | What's New | Feedback | Copyright and Disclaimer | Contact Us
2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
Online since 10th December, 2008