[Chromobacteria in human pathology; human chromobacterium infections].
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Chromobacterium violaceum infection is confined to the tropical and subtropical areas, with almost all reported cases occurring in the Southeast. The most common feature of this infection is sepsis, followed by cutaneous involvement and liver abscesses. Treatment consists of surgical drainage of purulent collections and appropriate antimicrobial therapy, such as chloramphenicol, gentamicin, imipenem, trimethoprim-sulfamethoxazole, or ciprofloxacin. Although C violaceum infection is rare, it is potentially fatal and remains an important entity for clinicians to suspect and treat appropriately.
Chromobacterium violaceum is a gram negative straight rod, 0.8-1.2 by 2.5 to 6.0 m, which is motile by one polar flagella and one to four lateral flagella. The organism inhabits soil and water and is often found in semitropical and tropical climates. Infections in humans are rare. We report a case of infection caused by strains of C. violaceum. A 38-year-old male patient was admitted to KyungHee University Hospital, Seoul, Korea on July 28th, 2003, after a car accident. The patient had multiple trauma and lacerations. He had an open wound in the left tibial area from which C. violaceum was isolated. The strain was resistant to ampicillin, tobramycin, ampicillin/sulbactam, ceftriaxone and cefepime, but was susceptible to amikacin, gentamicin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole and piperacillin/tazobactam. The patient was treated successfully by debridement, cephapirin sodium and astromicine sulfate.
We report the second case of infection with Chromobacterium violaceum that occurred in Brazil. A farm worker living in the State of São Paulo presented fever and severe abdominal pain for four days. At hospitalization the patient was in a toxemic state and had a distended and painful abdomen. Chest X-ray and abdominal ultrasound revealed bilateral pneumonia and hypoechoic areas in the liver. The patient developed failure of multiple organs and died a few hours later. Blood culture led to isolation of C. violaceum resistant to ampicillin and cephalosporins and sensitive to chloramphenicol, tetracyclin, aminoglicosydes, and ciprofloxacin. Autopsy revealed pulmonary microabscesses and multiple abscesses in the liver. The major features of this case are generally observed in infections by C. violaceum: rapid clinical course, multiple visceral abscesses, and high mortality. Because of the antimicrobial resistance profile of this Gram-negative bacillus, for appropriate empirical antibiotic therapy it is important to consider chromobacteriosis in the differential diagnosis of severe community infections in Brazil.
A case of systemic Chromobacterium violaceum infection, believed to be the first reported in a Papua New Guinean, is described. Autopsy disclosed multiple liver abscesses and the diagnosis was made by recovery of the organism from one of the abscesses. Aspects of management of this uncommon infection are discussed.
Chromobacterium violaceum is a saprophyte of soil and water in tropical and subtropical environments that is associated with rare but highly fatal infections in animals and humans. Systemic infection was diagnosed in two critically ill dogs from Florida. Fever was absent in both dogs. Both dogs were treated surgically and provided with intensive care, but only one survived. The identification of characteristic, violet-pigmented bacterial colonies on routine microbial cultures should alert microbiologists and clinicians to the likelihood of this dangerous pathogen. Because of the rapidly progressive nature of this infection, empirical antibiotic administration with fluoroquinolones should be employed pending susceptibility testing.
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Chromobacteriosis caused by Chromobacterium violaceum was diagnosed as an Assam macaque, Macaca assamensis, that died 4 days after receipt of the Yerkes Primate Center, It was received from a primate facility in Florida where it has been housed with a group of rhesus monkeys for 5 years. The animal died suddenly without showing any signs of clinical illness. Necropsy findings included extensive hepatic necrosis with the formation of multiple large cavitary lesions. Foci of necrosis were also found in the lungs and lymph nodes. Numerous gram-negative bacilli were demonstrable in the lesions and Chromobacterium violaceum was isolated from the blood, liver, lungs, spleen and kidneys.
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The authors report a rare case of Chromobacterium violaceum infection in a 2-month-old child. She presented with an apparently localized abscess, which appeared to respond well to therapy. However, the infection recurred later with a fulminant course. The organism frequently is dismissed as a contaminant or not identified properly, and the fatality rates are high. A high degree of awareness about this infection needs to be created, especially among pediatricians and pediatric surgeons, because children appear to be infected more commonly than adults, and aggressive therapy is needed to save these patients.
We report what we believe to be the first two known cases of Chromobacterium violaceum infection of the eye. One patient had conjunctivitis as the initial manifestation of an ultimately fatal infection. In the second patient, who suffered from chronic granulomatous disease of childhood, orbital cellulitis developed as part of a disseminated C violaceum infection from which he subsequently recovered. Infections caused by C violaceum may involve the eye and orbit. These infections are frequently fatal, but early recognition and aggressive treatment may result in a higher cure rate.
Chromobacterium violaceum is a gram-negative rod and is isolated from soil and water in tropical and subtropical regions. The species have pigmented and nonpigmented colony types. Infections caused by nonpigmented strains are rare. We report on two cases of infection caused by both pigmented and nonpigmented strains of C. violaceum. Two 24-year-old Korea Airline stewardesses were admitted to Inha University Hospital, Inchon, South Korea, on 9 August 1997, 3 days after an airplane accident in Guam. Both had multiple lacerations on exposed parts of their bodies. There was swelling, tenderness, and pus discharge. The wounds contained many small fragments of stones and weeds. A pigmented strain was isolated from the left hand and a nonpigmented strain was isolated from the left knee of one patient. For the other patient only a nonpigmented strain was isolated from a foot wound. The nonpigmented colonies from the left-knee and the left-foot wounds did not produce any pigment even after an extended period of incubation. The biochemical characteristics were the same for each strain except for oxidase and indole reactions. The pigmented strain was oxidase negative and indole positive, whereas the nonpigmented strains were oxidase positive and indole negative. The patients were successfully treated by debridement and with appropriate antibiotics.
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Human infection caused by Chromobacterium violaceum is rare, but when it occurs it is associated with a high mortality rate. We report the cases of two patients with infection due to Chromobacterium violaceum. One patient presented early in the course of disease and survived after receiving appropriate antibiotic therapy. The other patient presented late in the course of disease and died of fulminant sepsis with abscesses in multiple organs. We discuss the similarity between C. violaceum infection and the septicemic form of melioidosis.
Patients with chronic granulomatous disease are predisposed to infections by catalase-positive organisms in the environment. Chromobacterium violaceum is a catalase-positive bacterium whose saprophytic source in this country is the subtropical soil and water of the southeastern United States. Two patients with chronic granulomatous disease, followed at the National Institutes of Health in Maryland, acquired C. violaceum infections in Florida. All 10 cases previously reported were acquired in Florida and Louisiana, and reports for which dates were available showed that all infections were acquired from June to September. Seven of 10 patients died; one patient was studied and found to have chronic granulomatous disease. Thus, at least three of the 12 known patients have had underlying chronic granulomatous disease. We suggest that C. violaceum infections occur with unusual frequency in patients with a common underlying predisposing disorder; C. violaceum poses a potential threat to patients with chronic granulomatous disease living in or visiting the endemic states.
A 3.3-year-old boy developed Chromobacterium violaceum abscesses of lungs, liver and spleen and was successfully treated. He had chronic granulomatous disease (CGD). Twenty-five episodes of invasive C. violaceum infection in 24 children were reviewed. All 9 CGD and 10 nonbacteremic cases survived, but 12 of 16 (75%) non-CGD and 12 of 15 (80%) bacteremic patients died.