Title : A rare case report of elizabethkingia anophelis bacteremia in immunocompromised female
Abstract:
Case: A 74-year-old female with ESRD on HD, history of colostomy, and s/p liver transplant on immunosuppressants presented with fevers and weakness. Physical examination was remarkable for temperature of 101.1 and mild abdominal tenderness in the left lower quadrant. WBC was 18K. CT scan questioned possible cystitis. She was started on empiric treatment with Ceftriaxone IV. Blood cultures were positive for gram negative rods. Antibiotics were continued with initial clinical improvement and reduction in leucocytosis. On hospital day 4, she developed recurrent leucocytosis and worsening fatigue. Blood cultures then revealed E.anophelis, resistant to most commonly used antibiotics but sensitive to quinolones and TMP-SMX. The patient was switched to TMP-SMX orally and thereafter experienced full recovery.
Discussion: Elizabethkingia anophelis is a gram-negative, aerobic bacillus reported largely in immunocompromised patients. The first documented human infection occurred in 2011 in a neonate in the Central African Republic. What distinguishes this pathogen from other bacteria is its tendency towards resistance to many commonly used antibiotics. Our patient presented with sepsis and was treated effectively with a favorable outcome, however, there are other case reports worldwide where outcomes were less favorable despite varying treatments. Literature suggests water can be a source of infection, with some reports even being hospital-acquired through contaminated water. It is possible that in our immunocompromised patient, her colostomy or HD catheter could have been potential access points for bacterial infection, particularly if she had been exposed to contaminated water. It may be crucial to monitor water quality in hospitals and community settings to detect harmful bacteria that could lead to severe infections and implement appropriate preventive measures specifically with the at-risk population. There have also been reports of infection in other patients on HD. It is recommended that these patients be isolated and that contact tracing be conducted on those who shared dialysis settings to identify a potential source. Additionally, accurate, broad antimicrobial sensitivity testing is key to successful treatment.
Conclusion: E.anophelis is an emerging opportunistic pathogen, particularly in immunocompromised patients. It is prudent to not only recognize this infection as clinically significant and to select the appropriate antibiotic treatment but also to identify the potential source of infection to prevent additional cases. Further research is needed on the epidemiology of E.anophelis and other rare bacteria to better understand their behaviour, improve diagnostic methods, and develop effective treatment strategies.
