Atypical Chryseobacterium meningosepticum and Meningitis and Sepsis in Newborns and the Immunocompromised, Taiwan.From 1996 to 1999, 17 culture-documented systemic infections due to novel, atypical strains of Chryseobacterium meningosepticum Chryseobacterium meningosepticum Flavobacterium meningosepticum, CDC group IIa Bacteriology A bacterium of soil, water, plants, foods, hospital water–incubators, tap water, hemodialysis systems, pharmaceuticals Mode of transmission Uncertain, but occurred in two newborns and 15 immunocompromised immunocompromised /im·mu·no·com·pro·mised/ (-kom´pro-mizd) having the immune response attenuated by administration of immunosuppressive drugs, by irradiation, by malnutrition, or by certain disease processes (e.g., cancer). patients in a medical center in Taiwan. All clinical isolates, which were initially misidentified as Aeromonas salmonicida by an automated bacterial identification system, were resistant to a number of antimicrobial agents. The isolates were characterized as atypical strains of C. meningosepticum by complete biochemical investigation, 16S rRNA gene sequence analysis, cellular fatty acid fatty acid, any of the organic carboxylic acids present in fats and oils as esters of glycerol. Molecular weights of fatty acids vary over a wide range. The carbon skeleton of any fatty acid is unbranched. Some fatty acids are saturated, i.e. analysis, and random amplified polymorphic DNA fingerprinting DNA fingerprinting or DNA profiling, any of several similar techniques for analyzing and comparing DNA from separate sources, used especially in law enforcement to identify suspects from hair, blood, semen, or other biological materials found at (RAPD RAPD Randomly Amplified Polymorphic DNA RAPD relative afferent pupillary defect (ophthalmology; aka Marcus-Gunn Pupil) ). This is the first report of a cluster of atypically variant strains of C. meningosepticum, which may be an emerging pathogen emerging pathogen Public health Any pathogen that ↑ incidence of an epidemic outbreak Examples Cryptosporidium, E coli O157:H7, Hantavirus, multidrug resistant pneumococci, vancomycin-resistant enterococci. See Emergent disease. in newborns and the immunocompromised. Chryseobacterium meningosepticum, formerly known as Flavobacterium meningosepticum and CDC See Control Data, century date change and Back Orifice. CDC - Control Data Corporation II-a, is a gram-negative rod widely distributed in nature. The pathogen causes meningitis in premature and newborn infants (1-3) and pneumonia, endocarditis endocarditis (ĕn'dōkärdī`tĭs), bacterial or fungal infection of the endocardium (inner lining of the heart) that can be either acute or subacute. , postoperative bacteremia bacteremia: see septicemia. bacteremia Presence of bacteria in the blood. Short-term bacteremia follows dental or surgical procedures, especially if local infection or very high-risk surgery releases bacteria from isolated sites. , and meningitis usually associated with severe underlying illness in adults (4-7). Although C. meningosepticum infections are rare, accurate diagnosis is important because the species is usually resistant to multiple antibiotics, especially to those (including extended-spectrum [Beta]-lactam agents and aminoglycosides) typically prescribed for treatment of aerobic, gram-negative bacterial infections. Moreover, epidemics may occur, and a death rate as high as 55% has been reported in a nursery outbreak (8,9). Recent studies indicate that the species C. meningosepticum is highly heterogeneous and composed of many subgroups, which may be reclassified as separate species (10,11). Genetically defined subgroups within C. meningosepticum also differ in their pathogenicity (11). From September 1996 to March 1999, 17 culture-documented systemic infections due to a group of atypical C. meningosepticum strains occurred in two newborns and 15 immunocompromised patients in our institution. All isolates, which were initially misidentified as Aeromonas salmonicida, were resistant to a number of antimicrobial agents. The isolates were definitively identified as atypical strains of C. meningosepticum by full biochemical investigation, 16S rRNA gene sequence analysis, and cellular fatty acid analysis. Random amplified polymorphic DNA fingerprinting (RAPD) studies showed that these strains are distinct from bacteria of other genera tested, as well as from C. meningosepticum isolates from other geographic areas. Methods Patients and Bacterial Isolates From September 1996 to March 1999, 17 patients admitted to Chang Gung Memorial Hospital and Children's Hospital had clinical samples positive for A. salmonicida. Primary cultures from these patients showed pure growth of nonfastidious, glucose-nonfermenting bacilli bacilli /ba·cil·li/ (bah-sil´i) plural of bacillus. bacilli see bacillus. that were oxidase oxidase /ox·i·dase/ (ok´si-das) any enzyme of the class of oxidoreductases in which molecular oxygen is the hydrogen acceptor. ox·i·dase n. positive and nonmotile. The isolates were initially identified as A. salmonicida (%I.D. = 0.70) by the ID 32 GN Automatic Identification System (Biomerieux, St. Louis, MO), software version 3.2.2. Because this organism is a fish pathogen and has not been isolated in humans (12), we reviewed the charts of these patients. Clinical data for age, immunocompromising diseases, type of infection, and disease outcome were collected and analyzed. Infections were considered community acquired if the patient came to medical attention acutely ill, with an initial positive culture. Infections were considered nosocomial nosocomial /noso·co·mi·al/ (nos?o-ko´me-il) pertaining to or originating in a hospital. nos·o·co·mi·al adj. 1. Of or relating to a hospital. 2. if cultures were negative at the time of admission or if symptomatic disease developed after the first 72 hours of hospitalization. All 17 isolates were tested biochemically and identified as C. meningosepticum with atypical reactions. These conventional biochemical tests were incubated at 30 [degrees] C, and reactions were recorded after 2 days and 7 days of incubation in ambient air. Interpretation and identification were based on standard schema (13). Clinical isolates from four index cases (strains 96, 97-1, 97-2, and 97-3) were sent to the University of Maryland University of Maryland can refer to:
UIC participates in NCAA Division I Horizon League competition as the UIC Flames in several sports, most notably Basketball. Medical Center for confirmation with conventional biochemical methods; they were again identified as C. meningosepticum. Broth Microdilution Susceptibility Tests Broth microdilution MIC tests were performed and interpreted by National Committee for Clinical Laboratory Standards protocols (14), including cation-adjusted Mueller-Hinton broth (Difco Laboratories, Detroit, MI). A final inoculum inoculum /in·oc·u·lum/ (-ok´u-lum) pl. inoc´ula material used in inoculation. in·oc·u·lum n. pl. of 5 x [10.sup.5] CFU/mL and incubation for 16 to 20 h at 35 [degrees] C in ambient air were used. 16S rRNA Gene Sequence Analysis The MicroSeq[TM] 500 rDNA Bacterial Sequencing Kit (PE Biosystems, Foster City, CA) was used to amplify and sequence approximately the first 500 bp of the 16S rRNA gene, according to manufacturer's instructions. DNA sequencing with dRhodamine-labeled dye-terminators provided two overlapping strands of sequence data, with two sequencing primers. The sequence data were analyzed and assembled with AutoAssembler Software (PE Biosystems, Foster City, CA). Bacterial identification based on 16S rRNA gene sequence data, generation of the dendogram, and calculation of the percentage difference or genetic distance between sequences were performed with the MicroSeq[TM] Microbial microbial pertaining to or emanating from a microbe. microbial digestion the breakdown of organic material, especially feedstuffs, by microbial organisms. Identification and Analysis Software (PE Biosystems, Foster City, CA). Fatty Acid Analysis Whole-cell fatty acids were extracted and analyzed (15). Analysis was performed by using an automated Hewlett-Packard HP 5890 II Microbial Identification System (MIDI, Inc., Newark, DE). Fatty acid profiles were compared with a library of cell profiles of clinically relevant bacteria making up a similarity index. Random Amplified Polymorphic DNA Fingerprinting This polymerase chain reaction polymerase chain reaction (pŏl`ĭmərās') (PCR), laboratory process in which a particular DNA segment from a mixture of DNA chains is rapidly replicated, producing a large, readily analyzed sample of a piece of DNA; the process is (PCR PCR polymerase chain reaction. PCR abbr. polymerase chain reaction Polymerase chain reaction (PCR) )-based assay was performed as described (16). All bacterial strains were grown on L agar and incubated at 37 [degrees] C overnight. Three loops of bacterial colony were mixed with 250 [micro]L of Tween tween n. A child between middle childhood and adolesence, usually between 8 and 12 years old. [Blend of teen1 and between.] 20 and TE buffer and incubated at 94 [degrees] C for 20 min. After addition of 250 [micro]L of chloroform chloroform (klôr`əfôrm) or trichloromethane (trī'klôrōmĕth`ān), CHCl3 and centrifugation Centrifugation A mechanical method of separating immiscible liquids or solids from liquids by the application of centrifugal force. This force can be very great, and separations which proceed slowly by gravity can be speeded up enormously in centrifugal at 14,000 rpm for 4 min, the supernatant supernatant /su·per·na·tant/ (-na´tant) the liquid lying above a layer of precipitated insoluble material. supernatant the liquid lying above a layer of precipitated insoluble material. was collected, and the DNA DNA: see nucleic acid. DNA or deoxyribonucleic acid One of two types of nucleic acid (the other is RNA); a complex organic compound found in all living cells and many viruses. It is the chemical substance of genes. was quantified by UV absorbance absorbance /ab·sor·bance/ (-sor´bans) 1. in analytical chemistry, a measure of the light that a solution does not transmit compared to a pure solution. Symbol . 2. at [A.sub.260]. The primer sequence used to produce discriminatory fingerprinting profiles of bacterial strains was 5' GTCGATGTCG 3'. Each RAPD PCR reaction mixture (25 [micro]L) contained 15 ng of genomic DNA, 40 pmol of oligonucleotides, I unit of Taq polymerase (GIBCO-BRL, Gaithersburg, MD), 250 [micro]L deoxynucleoside triphosphate triphosphate /tri·phos·phate/ (tri-fos´fat) a salt containing three phosphate radicals. tri·phos·phate n. A salt or ester containing three phosphate groups. (Pharmacia, Laval, Quebec, Canada), 10 mM Tris-Cl (pH 8.0), 50 mM KCL KCL - Kyoto Common Lisp , 0.001% gelatin gelatin or animal jelly, foodstuff obtained from connective tissue (found in hoofs, bones, tendons, ligaments, and cartilage) of vertebrate animals by the action of boiling water or dilute acid. , and 3 mM [MgCl.sub.2]. Each reaction mixture was overlaid with 25 [micro]L of mineral oil and amplified with a Perkin-Elmer Cetus DNA Thermal Cycler model TC-1 according to the following profile: 4 cycles, each consisting of 5 min at 94 [degrees] C, 5 min at 36 [degrees] C, and 5 min at 72 [degrees] C; 30 cycles, each consisting of 1 min at 94 [degrees] C, 1 min at 36 [degrees] C, and 2 min at 72 [degrees] C; and a final extension step at 72 [degrees] C for 10 min. PCR-amplified products were separated by 1.5% agarose gel electrophoresis Agarose gel electrophoresis is a method used in biochemistry and molecular biology to separate DNA, RNA, or protein molecules by size. This is achieved by moving negatively charged nucleic acid molecules through an agarose matrix with an electric field (electrophoresis). and, after staining, were visualized and photographed under LTV LTV See: Loan-to-value ratio illumination. RAPD was performed twice on each strain, and fingerprinting was also analyzed twice. Final comparison was done by visual analysis, as well as Molecular Analyst Fingerprinting Plus Software (Bio-Rad, Ontario, Canada). We also used RAPD to examine four clinical isolates of C. meningosepticum, one Klebsiella pneumoniae Klebsiella pneu·mo·ni·ae n. Friedlander's bacillus. , and two Burkholderia cepacia Burkholderia cepacia Pseudomonas cepacia Bacteriology A bacterium found in the environment–eg, plants, water, soil, and in hospital environment, which may colonize the respiratory tract of Pts with cystic fibrosis; transmitted by direct physical , along with the Pseudomonas aeruginosa strain P1 (16) as controls. Results The first patient was a 3-day-old, full-term neonate neonate /neo·nate/ (ne´o-nat) newborn infant. ne·o·nate n. A neonatal infant. neonate a newborn animal. who was transferred to our center for the treatment of early-onset neonatal sepsis and meningitis in September 1996. The infections of this index patient and of another newborn were presumed to be perinatally acquired, although culture of the cervix of the mothers was negative for this organism. Most of the other infected patients were immunocompromised (Table 1). Age [is greater than] 60 years and long-term hospital stay also appear to be risk factors for the infection. All infected patients [is less than] 60 years of age had substantial immunosuppressive Immunosuppressive Any agent that suppresses the immune response of an individual. Mentioned in: Antirheumatic Drugs, Graft-vs.-Host Disease, Immunosuppressant Drugs immunosuppressive 1. pertaining to or inducing immunosuppression. 2. underlying diseases (Table 1). Three of the 15 nonneonatal patients died of the infection; the two newborns survived, but with severe neurologic sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention , despite antibiotic treatment. After the first case in 1996 and three consecutive infections due to this unusual organism in early 1997, we initiated a surveillance system to monitor all infections caused by the organism in our hospital. Table 1. Clinical features of patients Infection Age Underlying disease(s) Neonatal diseases Sepsis, meningitis 3D None Sepsis, meningitis 2D None Community-acquired infection Sepsis 65Y Cirrhosis of the liver Sepsis 68Y Congestive heart failure Sepsis 7Y IgA nephropathy Sepsis, cellulitis 84Y Hypertension Sepsis 24Y Aplastic anemia Sepsis 43Y Chronic renal failure Hospital-acquired infection Sepsis 18Y Acute lymphocytic leukemia Sepsis 62Y Cirrhosis of the liver Sepsis, wound infection 49Y Burn Sepsis, wound infection 37Y Burn Sepsis 42Y Common bile duct cancer Sepsis 84Y Brain infarction Sepsis 72Y Myocardial infarction Sepsis 19Y Pelvic fracture Sepsis 68Y Tuberculosis Infection Source of cultures Neonatal diseases Sepsis, meningitis Blood, CSF Sepsis, meningitis Blood, CSF Community-acquired infection Sepsis Blood Sepsis Blood Sepsis Blood Sepsis, cellulitis Blood Sepsis Blood Sepsis Blood Hospital-acquired infection Sepsis Blood Sepsis Blood Sepsis, wound infection Blood, wound Sepsis, wound infection Blood, wound Sepsis Blood Sepsis Blood Sepsis Blood Sepsis Blood Sepsis Blood Infection Date of isolation Neonatal diseases Sepsis, meningitis 09/13/1996 Sepsis, meningitis 01/24/1999 Community-acquired infection Sepsis 12/04/1997 Sepsis 08/09/1997 Sepsis 02/11/1998 Sepsis, cellulitis 04/06/1997 Sepsis 03/11/1999 Sepsis 04/10/1997 Hospital-acquired infection Sepsis 06/01/1997 Sepsis 02/05/1999 Sepsis, wound infection 06/29/1997 Sepsis, wound infection 11/13/1997 Sepsis 10/10/1997 Sepsis 05/24/1997 Sepsis 08/17/1998 Sepsis 03/10/1998 Sepsis 03/20/1998 Y = years; D = days; CSF Cerebrospinal Fluid (CSF) Analysis Definition Cerebrospinal fluid (CSF) analysis is a laboratory test to examine a sample of the fluid surrounding the brain and spinal cord. = cerebrospinal fluid. Biochemical properties of the isolates were nearly identical to those of typical C. meningosepticum (17), except that 8 of the 17 isolates (47%) were positive for nitrite nitrite Any salt or ester of nitrous acid (HNO2). The salts are inorganic compounds with ionic bonds, containing the nitrite ion (NO2−) and any cation. reduction and none of them grew on MacConkey agar. Colonies of these isolates were pale yellow on blood agar plates. All the isolates were nonmotile and oxidase-positive, hydrolyzed esculin and gelatin, were positive for o-nitrophenyl-[Beta]-D-galactopyranoside, and produced indole indole /in·dole/ (in´dol) a compound obtained from coal tar and indigo and produced by decomposition of tryptophan in the intestine, where it contributes to the peculiar odor of feces. It is excreted in the urine in the form of indican. . However, as described (17), the indole reaction was only weakly positive after a 48-h incubation at 30 [degrees] C, and a more robust reaction was observed with inoculation into heart infusion broth rather than tryptophan tryptophan (trĭp`təfăn), organic compound, one of the 20 amino acids commonly found in animal proteins. Only the l-stereoisomer appears in mammalian protein. broth. The four index strains were also tested with other automated systems, including the API 20E, API 20NE, and Vitek GNI GNI Gross National Income GNI Global Nomads International GNI Guyana News and Information GNI Gay Naturists International GNI Global Netoptex Inc. GNI Great Northern Iron GNI Gebäude Netzwerk Institut (German) + rapid identification systems (Biomerieux, St. Louis, MO). On API 20E, all four isolates gave a profile number of 106300400, which was interpreted as an "unacceptable profile" in the 20E database. On API 20NE, four different profile numbers were generated for the four strains (2476305, strain 96; 2476304, strain 97-1; 3476306, strain 97-2; and 2456304, strain 97-3). Profiles for three of the four strains were interpreted as "excellent identification" at 99.9% for C. meningosepticum. The profile number of 3476306 for strain 97-2 was interpreted as "doubtful" at 99.1%, but the only possible choice listed for organism identification was C. meningosepticum. By using the Vitek GNI+ card, we generated a profile number of 62022000040 for three of the four isolates, giving an interpretation of C. meningosepticum at 99%. Strain 97-2 gave a slightly different profile number of 60022000040, but with a 97% match for C. meningosepticum. An old version of software was installed for use with the ID 32 GN Automatic Identification system (Biomerieux, St. Louis, MO) in the original identification of these isolates; this software was unable to correctly identify them as C. meningosepticum. We updated the database with a newer version 3.6.8 in May 1999. When the originally misidentified isolates were rerun re·run n. The act or an instance of rebroadcasting a recorded movie or a recorded television performance. tr.v. re·ran , re·run, re·run·ning, re·runs To present a rerun of. through the updated database, C. meningosepticum was the first choice (%I.D. = 1.00), with A. salmonicida as the second choice (%I.D. = 0.70). No cases of A. salmonicida infection have been identified in our laboratory since May 1999. MIC results for the 17 clinical strains from Taiwan were determined by the broth microdilution method (Table 2). All the agents tested except piperacillin and ciprofioxacin had poor in-vitro activities against these organisms. Comparative sequence analysis with the MicroSeq system revealed that the four index isolates share the same sequence, which clustered most closely with the type strain of C. meningosepticum (Figure 1); however, the genetic distance of 2.7% suggests that these isolates may represent either an atypical biovar of C. meningosepticum or a novel species within the genus (18). Cellular fatty acid analysis indicated that these isolates were close to C. meningosepticum, with a similarity index of 0.94. The major peaks were i-15:0 (38.5%), i-3-OH 17:0 (15.9%), and i-17:1 (7.8%). Table 2. Comparative in vitro activity of various antibiotics against 17 strains of atypical Chryseobacterium meningosepticum
MIC ([micro]g/mL)
Antibiotic Range [MIC.sub.50] [MIC.sub.90]
Ampicillin 16-64 32 32
Ticarcillin 32->128 128 >128
Piperacillin 1-128 8 32
Cephalothin 32->32 32 32
Cefamandole 16->32 >32 >32
Cefotaxime 8->32 32 >32
Ceftriaxone 8->32 16 32
Imipenem 1->32 32 32
Ceftazidime 2-64 16 >32
Gentamicin 16-64 32 64
Amikacin 2-64 64 64
Ciprofioxacin 0.25-16 1 4
[Figure 1 ILLUSTRATION OMITTED] Eight RAPD fingerprints were obtained from the 17 C. meningosepticum isolates, which differed genetically, based on RAPDs, from the other four clinical C. meningosepticum strains from Canadian patients with bacteremia. The RAPD typing results of the four index isolates, 96, 97-1, 97-2, and 97-3, were compared with those of other closely related gram-negative bacteria (Figure 2). Using this typing method, we identified an apparently conserved 0.4-kb fragment in the DNA fingerprints of the 17 isolates. This genetic marker was absent from other glucose-nonfermenting bacteria, such as Pseudomonas Pseudomonas A genus of gram-negative, nonsporeforming, rod-shaped bacteria. Motile species possess polar flagella. They are strictly aerobic, but some members do respire anaerobically in the presence of nitrate. and Burkholderia, as well as the glucose-fermenter Klebsiella klebsiella Any of the rod-shaped bacteria that make up the genus Klebsiella. They are gram-negative (see gram stain), thrive better without oxygen than with it, and do not move. K. , but present in one Canadian C. meningosepticum strain (Figure 2). Furthermore, C. meningosepticum, B. cepacia, P. aeruginosa strain P1, and K. pneumoniae differed in terms of their RAPD fingerprints. [Figure 2 ILLUSTRATION OMITTED] Discussion Our study provides evidence of the emergence of a group of atypical strains of C. meningosepticum causing systemic infections of patients in Taiwan. This conclusion is based on phylogenetic phy·lo·ge·net·ic adj. 1. Of or relating to phylogeny or phylogenetics. 2. Relating to or based on evolutionary development or history. clustering of the four index strains according to 16S rRNA gene sequence analysis and the similarity of the biochemical characteristics, cellular fatty acid profiles, and antibiograms expressed by all 17 isolates. However, unequivocal evidence of these strains as a new species within the genus Chryseobacterium will require confirmation by DNA-DNA hybridization studies. The emergence of this specific biovar of the 17 strains has important clinical implications. First, this organism is highly pathogenic for newborn infants and immunocompromised patients, usually causing nosocomial as well as community-acquired systemic infections with substantial rates of illness and death. Second, rapid, accurate identification of the strain may be challenging for clinical microbiology laboratories. An automated bacterial identification system such as the ID 32 GN (Biomerieux, St. Louis, MO), initially misidentified all 17 isolates reported in this study as A. salmonicida. The reason for the misidentification remains unclear, although both A. salmonicida and C. meningosepticum are relatively biochemically inert and share some common biochemical characteristics, such as being esculin hydrolysis- and gelatin hydrolysis-positive and motility motility /mo·til·i·ty/ (mo-til´ite) the ability to move spontaneously.mo´tile Motility Motility is spontaneous movement. negative. That A. salmonicida is truly indole negative may be a clue, but a positive indole reaction for these atypical strains was difficult to obtain without special conventional test media and conditions. Because this ID 32 GN system is widely used in many clinical microbiology laboratories for the identification of gram-negative rods (19), this system should be updated or modified to improve its proficiency in identifying this as well as other emerging pathogens. Third, as with typical C. meningosepticum, choosing optimal antibiotic regimens for treating infections caused by the atypical strain was difficult because of the multidrug-resistant nature of the organism. All 17 clinical isolates were resistant to various antimicrobial agents, especially [Beta]-lactam antibiotics and aminoglycosides. The most effective drug we tested in this study was ciprofioxacin. The only other drug displaying better activity was piperacillin; however, its MIC values appeared higher, and 4 of the 17 isolates showed high-level resistance ([Beta] 16 mg/mL). The role of fluoroquinolones in the treatment of C. meningosepticum infections may be important because of their low MICs (20,21). Successful response to treatment has also been reported with trimethoprim-sulfamethoxazole, vancomycin, rifampin rifampin (rĭfăm`pĭn), antibiotic used in the treatment of tuberculosis. It is also used to eliminate the meningococcus microorganism from carriers and to treat leprosy, or Hansen's disease. , clindamycin, and erythromycin erythromycin (ĭrĭth'rōmī`sĭn), any of several related antibiotic drugs produced by bacteria of the genus Streptomyces (see antibiotic). (2,4,5,9), antibiotics mainly used for treating gram-positive bacterial infections. Most of these potentially effective antibiotics will not be included in the panel of susceptibility testing for any commonly isolated gram-negative bacteria other than Chryseobacterium. Therefore, accurate identification of these strains by either complete biochemical investigation or updated automated identification systems is crucial in selecting appropriate antimicrobial susceptibility testing and proper antibiotic therapy. The 17 isolates from patients with systemic infections in Taiwan generated RAPD fingerprints that differed substantially from those of C. meningosepticum strains from Canada. Even among the 17, 8 different RAPD types were identified. Using RAPD typing, we identified an apparently conserved 0.4-kb fragment in the DNA fingerprints of the 17 isolates. This genetic marker was absent from the types of other glucose-nonfermenting bacteria, such as Pseudomonas and Burkholderia and the glucose-fermenter Klebsiella. However, one Canadian C. meningosepticum isolate had this specific genetic marker, suggesting that the atypical C. meningosepticum biovar of strains reported in this study may have been present in North America. Only a specific ribotype has been reported as an epidemiologic marker of C. meningosepticum in human infections (11). Whether the 0.4-kb band will be useful as an epidemiologic marker or represents a unique virulence factor is the subject of further studies. In summary, we present evidence for the emergence of a cluster of atypical C. meningosepticum strains in Taiwan. This organism, which is highly pathogenic for newborns and immunocompromised patients, may be misidentified by some commercially available kit systems even at the genus level. Complete conventional biochemical testing is useful for an accurate identification. Such identification would provide clinicians with important information about the pathogenic capability of a strain and its general susceptibility profile. Acknowledgments We thank David P. Speert and Diane Roscoe for providing the Canadian clinical C. meningosepticum strains used in this study, as well as isolates of Klebsiella pneumoniae and Burkholderia cepacia. This study was funded in part by grant NSC NSC abbr. National Security Council Noun 1. NSC - a committee in the executive branch of government that advises the president on foreign and military and national security; supervises the Central Intelligence Agency 89-2314-B-182A-010 from the National Science Council, The Executive Yuen, Taiwan. References (1.) King EO. Studies of a group of previously unclassified bacteria associated with meningitis in infants. Am J Clin Pathol 1959;31:241-7. (2.) Maderazo EG, Bassaris HP, Quintiliani R. Flavobacterium meningosepticum meningitis in a newborn infant: treatment with intraventricular erythromycin. J Pediatr 1974;85:675-6. (3.) Thong ML, Puthucheary SD, Lee E. Flavobacterium meningosepticum infection: an epidemiologic study in a newborn nursery. J Clin Pathol 1981;34:429-33. (4.) Bloch KC, Nadarajah R, Jacobs R. Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Medicine 1997;76:30-41. (5.)Teres teres /te·res/ (te´rez) [L.] long and round. te·res adj. Being round and long. Used of certain muscles and ligaments. teres [L.] long and round. D. ICU-acquired pneumonia due to Flavobacterium meningosepticum. JAMA JAMA abbr. Journal of the American Medical Association 1974;228:732. (6.) Olson HW, Fredricksen WC, Siboni KE. Flavobacterium meningosepticum in eight non-fatal cases of postoperative bacteremia. Lancet 1965;1:1294-6. (7.) Werthamer S, Weiner M. Subacute bacterial endocarditis subacute bacterial endocarditis n. Abbr. SBE A subacute bacterial infection of the endocardium or heart valves, most frequently seen in patients with congenital or acquired valvular or cardiac defects, characterized by a heart murmur and due to Flavobacterium meningosepticum. Am J Clin Pathol 1971;57:410-2. (8.) Von Graevenitz A. Ecology, clinical significance, and antimicrobial susceptibility of infrequently encountered glucose-nonfermenting gram-negative rods. In: Gilardi GL, editor. Nonfermentative gram-negative rods: laboratory identification and clinical aspects. New York: Marcel Dekker, Inc.; 1985. p. 181-232. (9.) Schreckenberger PC, von Graevenitz A. Acinetobacter, Achromobacter, Alcaligenes, Moraxella, Methylobacterium, and other nonfermentative gram-negative rods. In: Murray PR, Barron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Manual of clinical microbiology. Seventh ed. Washington: American Society for Microbiology The American Society for Microbiology (ASM) is a scientific organization, based in the United States although with over 43,000 members throughout the world. It is the largest single life science professional organization and its members include those whose interests encompass basic ; 1999. p. 539-60. (10.) Ursing J, Bruun B. Genetic heterogeneity of Flavobacterium meningosepticum demonstrated by DNA-DNA hybridization. Acta Pathol Microbiol Immunol Scand Sect B 1987;95:33-9. (11.) Colding H, Bangsborg J, Fiehn N, Bennekov T, Bruun B. Ribotyping for differentiating Flavobacterium meningosepticum isolates from clinical and environmental sources. J Clin Microbiol 1994;32:501-5. (12.) Carnahan AM, Altwegg M. Taxonomy. In: Austin B, editor. The genus Aeromonas. New York: John Wiley & Sons, Inc.; 1996. p. 1-38. (13.) Koneman EW, Allen DS, Janda WM, Schreckenberger PC, Winn WC Jr. Color atlas and textbook of diagnostic microbiology. Fifth edition. Philadelphia: JB Lippincott Co.; 1997. (14.) National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Fourth edition. Approved standard M4-A4. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. (15.) Welch DF. Application of cellular fatty acid analysis. Clin Microbiol Rev 1998;4:422-38. (16.) Mahenthiralingam E, Campbell M, Henry D, Speert DP. Random amplified polymorphic DNA typing of Pseudomonas aeruginosa isolates recovered from patients with cystic fibrosis. J Clin Microbiol 1996;34:129-35. (17.) Schreckenberger PC. Emended e·mend tr.v. e·mend·ed, e·mend·ing, e·mends To improve by critical editing: emend a faulty text. classification and description of the family Flavobacterium and the genus Sphingobacterium. Clin Microbiol Newslett 1998;20:115-20. (18.) Montgomery S, Anderson S, Waddington M, Bartell J, Nunn G, Foxall P. Variation in bacterial interspecific in·ter·spe·cif·ic adj. Arising or occurring between species. interspecific also interspecies Arising or occurring between species. Adj. 1. genetic distances-a new set of rules for interpretation of 16S rRNA sequences. In: Program and abstracts of the IXth International Congress of Bacteriological bac·te·ri·ol·o·gy n. The study of bacteria, especially in relation to medicine and agriculture. bac·te and Applied Microbiology, Sydney, Australia; 1999. (19.) Altwegg M, Zollinger-Iten J. Identification of Enterobacteriaceae, Aeromonas spp. and Plesiomonas shigelloides with ATB ATB Antibiotic ATB All The Best ATB Ability to Benefit ATB André Tanneberger (musician) ATB Across the Board ATB Active Time Battle (roleplaying game) ATB All Terrain Bike ATB Alberta Treasury Branches 32 GN System. J Microbiol Methods 1987;7:103-9. (20.) Husson MO, Izard Iz´ard n. 1. (Zool.) A variety of the chamois found in the Pyrenees. D, Bouillet L, Lechere H. Comparative in-vitro activity of ciprofioxacin against non-fermenters. J Antimicrob Chemother 1985;15:457-62. (21.) Fraser S, Jorgensen JH. Reappraisal of the antimicrobial susceptibilities of Chryseobacterium and Flavobacterium species and methods for reliable susceptibility testing. Antimicrob Agents Chemother 1997;41:2738-41. Address for correspondence: Cheng-Hsun Chiu, Department of Pediatrics, Chang Gung Children's Hospital, 5 Fu-Shin Street, Kweishan 333, Taoyuan, Taiwan; fax: 886 3 3288957; e-mail: chnchiu@ms34.hinet.net. Cheng-Hsun Chiu,(*) Michael Waddingdon,[dagger] Wu-Shiun Hsieh,(*) David Greenberg,[double dagger] Paul C. Schreckenberger, [sections] and Amy M. Carnahan [paragraph] (*) Chang Gung Children's Hospital, Taoyuan, Taiwan; [dagger] Accugenix, Inc., Newark, Delaware; [double dagger] British Columbia's Children's Hospital BC Children's Hospital is a medical facility located in Vancouver, British Columbia. and is an agency of the Provincial Health Services Authority. BC Children's specializes in health care for patients from birth and infancy up to age 16. , Vancouver, British Columbia, Canada; [sections] University of Illinois at Chicago Medical Center, Chicago, Illinois, USA; [paragraph] University of Maryland School of Medicine, Baltimore, Maryland, USA Dr. Cheng-Hsun Chiu is assistant professor of Pediatrics, Chang Gung Children's Hospital and Chang Gung University. His research interests include bacterial pathogenesis and molecular epidemiology of bacterial infections. |
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