Rare Elizabethkingia anophelis meningitis case in a Danish male Open Access

Abstract

Introduction. Elizabethkingia anophelis is a Gram-negative, aerobic, non-motile rod belonging to the family Flavobacteriaceae. Over the last 5 years, it has emerged as an opportunistic human pathogen involved in neonatal meningitis and sepsis, as well as nosocomial outbreaks. It has been isolated from the midgut of the Anopheles gambiae mosquito, but there is no evidence for a role of the mosquito in human infections, and very little is known regarding the routes of transmission to humans. Recent studies, primarily from South-East Asia, suggest that E. anophelis, and not Elizabethkingia meningoseptica, is the predominant human pathogen of this genus. However, identification to the species level has been difficult due to the limitations of the current MALDI-TOF MS (matrix-associated laser desorption ionization-time of flight MS) systems for correct species identification.

Case presentation. Here, we present a rare case of E. anophelis meningitis in a Danish male, who had a travel exposure to Malaysia 7 weeks before hospitalization. A multidrug-resistant Elizabethkingia species was isolated from blood and cerebrospinal fluid, and genomic sequencing was used to characterize the phylogenetic position of the isolate, which was determined as associated with previously described sublineage 11. The patient was successfully treated with intravenous moxifloxacin and rifampicin for 2 weeks with no major sequelae, but we did not find the source of transmission.

Conclusion. All clinical microbiologists should be aware of the present limitations of the MALDI-TOF MS systems for correct species identification, and therefore we recommend the use of genome sequencing for the correct identification at the species and sublineage level.

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2018-08-09
2024-03-29
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References

  1. Kim KK, Kim MK, Lim JH, Park HY, Lee ST. Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. Int J Syst Evol Microbiol 2005; 55:1287–1293 [View Article][PubMed]
    [Google Scholar]
  2. Janda JM, Lopez DL. Mini review: new pathogen profiles: Elizabethkingia anophelis. Diagn Microbiol Infect Dis 2017; 88:201–205 [View Article][PubMed]
    [Google Scholar]
  3. Breurec S, Criscuolo A, Diancourt L, Rendueles O, Vandenbogaert M et al. Genomic epidemiology and global diversity of the emerging bacterial pathogen Elizabethkingia anophelis. Sci Rep 2016; 6:30379 [View Article][PubMed]
    [Google Scholar]
  4. Jean SS, Lee WS, Chen FL, Ou TY, Hsueh PR. Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections. J Hosp Infect 2014; 86:244–249 [View Article][PubMed]
    [Google Scholar]
  5. Eriksen HB, Gumpert H, Faurholt CH, Westh H. Determination of Elizabethkingia diversity by MALDI-TOF mass spectrometry and whole-genome sequencing. Emerg Infect Dis 2017; 23:320–323 [View Article][PubMed]
    [Google Scholar]
  6. Kämpfer P, Matthews H, Glaeser SP, Martin K, Lodders N et al. Elizabethkingia anophelis sp. nov., isolated from the midgut of the mosquito Anopheles gambiae. Int J Syst Evol Microbiol 2011; 61:2670–2675 [View Article][PubMed]
    [Google Scholar]
  7. Frank T, Gody JC, Nguyen LB, Berthet N, Le Fleche-Mateos A et al. First case of Elizabethkingia anophelis meningitis in the Central African Republic. Lancet 2013; 381:1876 [View Article][PubMed]
    [Google Scholar]
  8. Bobossi-Serengbe G, Gody JC, Beyam NE, Bercion R. [First documented case of Chryseobacterium meningosepticum meningitis in Central African Republic]. Med Trop 2006; 66:182–184 (in French) [PubMed]
    [Google Scholar]
  9. Lau SK, Chow WN, Foo CH, Curreem SO, Lo GC et al. Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality. Sci Rep 2016; 6:26045 [View Article][PubMed]
    [Google Scholar]
  10. Lin JN, Yang CH, Lai CH, Huang YH, Lin HH. Draft genome sequence of Elizabethkingia anophelis strain EM361-97 isolated from the blood of a cancer patient. Genome Announc 2016; 4:e01215-16 [View Article][PubMed]
    [Google Scholar]
  11. Chew KL, Cheng B, Lin RTP, Teo JWP. Elizabethkingia anophelis Is the dominant Elizabethkingia species found in blood cultures in Singapore. J Clin Microbiol 2018; 56:e0144517 [View Article][PubMed]
    [Google Scholar]
  12. Perrin A, Larsonneur E, Nicholson AC, Edwards DJ, Gundlach KM et al. Evolutionary dynamics and genomic features of the Elizabethkingia anophelis 2015 to 2016 Wisconsin outbreak strain. Nat Commun 2017; 8:15483 [View Article][PubMed]
    [Google Scholar]
  13. King EO. Studies on a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol 1959; 31:241–247 [View Article][PubMed]
    [Google Scholar]
  14. Zankari E, Hasman H, Cosentino S, Vestergaard M, Rasmussen S et al. Identification of acquired antimicrobial resistance genes. J Antimicrob Chemother 2012; 67:2640–2644 [View Article][PubMed]
    [Google Scholar]
  15. Bellais S, Aubert D, Naas T, Nordmann P. Molecular and biochemical heterogeneity of class B carbapenem-hydrolyzing beta-lactamases in Chryseobacterium meningosepticum. Antimicrob Agents Chemother 2000; 44:1878–1886 [View Article][PubMed]
    [Google Scholar]
  16. Teo J, Tan SY, Liu Y, Tay M, Ding Y et al. Comparative genomic analysis of malaria mosquito vector-associated novel pathogen Elizabethkingia anophelis. Genome Biol Evol 2014; 6:1158–1165 [View Article][PubMed]
    [Google Scholar]
  17. Han MS, Kim H, Lee Y, Kim M, Ku NS et al. Relative prevalence and antimicrobial susceptibility of clinical isolates of Elizabethkingia species based on 16S rRNA gene sequencing. J Clin Microbiol 2017; 55:274–280 [View Article][PubMed]
    [Google Scholar]
  18. Shinha T, Ahuja R. Bacteremia due to Elizabethkingia meningoseptica. IDCases 2015; 2:13–15 [View Article][PubMed]
    [Google Scholar]
  19. Grayson ML, Cosgrove SE, Crowe S, Hope W, McCarthy JS et al. Kucers' The Use of Antibiotics: A Clinical Review of Antibacterial, Antifungal, Antiparasitic, and Antiviral Drugs, 7th ed. Boca Raton: CRC Press; 2017
    [Google Scholar]
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