MENINGITIS AND BACTEREMIA BY CHRYSEOBACTERIUM INDOLOGENES IN AN IMMUNODEFICIENT PATIENT: CASE REPORT

• DOI: https://doi.org/10.22533/at.ed.1594162405012

• Palavras-chave: Meningitis; Bacteremia; Chryseobacterium indologenes; Immunodeficiency.

• Keywords: Meningitis; Bacteremia; Chryseobacterium indologenes; Immunodeficiency.

• Abstract:

  INTRODUCTION: Chryseobacterium indologenes (CI) is an aerobic gram-negative bacillus present in nature, but is rarely present in human microflora. This pathogen can be aggressive, causing significant morbidity and mortality among patients with predisposing conditions, such as extremes of age, prolonged antibiotic therapy, recent surgery, immunodeficiency, malignancies, presence of invasive devices and prolonged use of catheters. Thus, it is considered a multidrug-resistant nosocomial bacterium, but it is rarely found as a cause/pain of bacteremia or meningitis. CASE REPORT: Patient, 58 years old, admitted to the HGCC in January 2023 to undergo chemotherapy for Type B Acute Lymphoid Leukemia. Initially, she developed severe mucositis and profound febrile neutropenia, with empirical antibiotic therapy being instituted initially and, subsequently, guided by urine and blood cultures. The multidrug-resistant spectrum CI was isolated in blood culture, and, through discussions with the Hospital Infection Control Committee (CCIH), therapies were instituted. The patient presented with a seizure, which led to a cerebrospinal fluid culture, in which Chryseobacterium indologenes was identified. Furthermore, she presented a reduced level of consciousness and respiratory instability, being taken to the intensive care unit, but later progressing to brain death. DISCUSSION: Although Chryseobacterium spp is less prevalent than other pathogens and has lower virulence, it gains notoriety as it becomes an organism that causes serious and multidrug-resistant infections. C. indologenes is a species intrinsically resistant to aminoglycosides, first-generation cephalosporins, aminopenicillins and aztreonam, which limits therapeutic options. The emergence of carbapenem-resistant strains of C. indologenes has further restricted antibiotic therapy. Studies have shown that quinolones have the greatest activity against C. indologenes. CONCLUSION: The treatment of critical patients involves great concern on the part of the healthcare team, especially in shortening the length of stay, preventing the transmission of hospital pathogens and avoiding the use of extended-spectrum antibiotics. The literature demonstrates that multiresistant strains of C. indologenes are becoming a threat in hospital environments. Furthermore, new studies on the multidrug-resistant pathogen need to be developed mainly in the context of care for complex patients.