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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 468-470

Sphingomonas paucimobilis - A Rare Cause of Community-Acquired Pneumonia


Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University) ,Wardha, Maharashtra, India

Date of Submission13-Apr-2020
Date of Decision20-May-2020
Date of Acceptance15-Jun-2020
Date of Web Publication1-Feb-2021

Correspondence Address:
Dr. Pankaj Wagh
Department of Respiratory Medicine, Jawaharlal Nehru Medical College, Sawangi, Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_111_20

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  Abstract 


Nonresolving pneumonia (NRP) is a common diagnostic challenge encountered in daily practice. Sphingomonas paucimobilis grows easily in hospital equipment. However, it is also an emerging pathogen and not just a contaminant of hospital setup. Most of the S. paucimobilis infections reported in the literature have been health care associated, but contrary to the recent publications, we revealed a community-acquired infection. Due to its low virulent features of bacteria, it is not associated with serious life-threatening infections, but with increasing number of case reports, it should be considered as an important pathogen in NRP. We report a case of a 35-year-old female presenting with? Nonresolving pneumonia c/o cough with expectoration for 10 months and low-grade fever for 2 months. She had received multiple courses of antibiotics including intravenous beta-lactams and macrolide. Her blood investigations were normal. Her sputum? dsAFB was negative. Her initial chest X-ray (CXR) was suggestive of bilateral lower zone consolidation. Computed tomography thorax was suggestive of right middle lobe and left lingular lobe consolidation. Bronchoscopy was normal except for pus flakes seen in the left lingular lobe. Reports of BAL were negative for dsAFB, AFB?CBNAAT, and malignant cells. Culture and sensitivity report was suggestive of growth of S. paucimobilis sensitive to meropenem, third-generation cephalosporins, fluoroquinolones, and aminoglycosides. The patient was started on meropenem and amikacin for 10 days, and the patient's repeat CXR showing a significant resolution was hence discharged on levofloxacin for 7 days.

Keywords: Community-acquired pneumonia, nonresolving pneumonia, Sphingomonas paucimobilis


How to cite this article:
Wagh P, Ghewade B. Sphingomonas paucimobilis - A Rare Cause of Community-Acquired Pneumonia. J Datta Meghe Inst Med Sci Univ 2020;15:468-70

How to cite this URL:
Wagh P, Ghewade B. Sphingomonas paucimobilis - A Rare Cause of Community-Acquired Pneumonia. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Mar 4];15:468-70. Available from: http://www.journaldmims.com/text.asp?2020/15/3/468/308536




  Introduction Top


Nonresolving pneumonia (NRP) is a common diagnostic challenge encountered in day-to-day practice. Sphingomonas paucimobilis is a Gram-negative bacillus in both environmental and hospital settings. When reported, it is most commonly from nosocomial infections associated with catheters, urinary tract infections, soft-tissue infections, and very rarely pneumonia. There are only a few comprehensive literature reviews concerning bacteremia associated with S. paucimobilis. We present a case report of nonresolving consolidation due to an uncommon low virulence organism S. paucimobilis which is reported scarcely in the literature. Most of the cases reported are in immunocompromised hosts but also can infect healthy people.


  Case Report Top


A 35-year-old female presented in the respiratory medicine outpatient department with chief presenting complaints of cough for 2 months and low-grade fever for 2 months. Cough was productive with scanty mucoid expectoration, with no diurnal variation and aggravating or relieving factors. The patient had fever which was of low grade and not associated with chills or rigors. There was no history of breathlessness, hemoptysis, and chest pain. The patient had received multiple courses of antibiotics including macrolides and penicillin derivatives. There was no significant past/family/personal history. On general examination, vitals were stable, O2 saturation was 96% at room air, no pallor, no cyanosis, no clubbing, and no lymphadenopathy.

On respiratory examination, the upper respiratory tract was normal. The lower respiratory tract reveals no abnormalities on inspection and palpation. On percussion, dull note heard over bilateral infrascapular and inframammary area. On auscultation in infrascapular, infra-axillary, and infra-mammary area, coarse crepts were present. Other systems were normal. Provisional diagnosis was bilateral lower zone NRP. Routine investigations were done, shows raised total leukocyte count – 15,800 cells/mm3 with neutrophilia, hemoglobin was 10.6 g%, random blood sugar was 98 mg/dl, normal liver function test and kidney function test reports, sputum smear was negative for AFB, HIV test was nonreactive.

X-ray chest posteroanterior (PA) view was suggestive of bilateral lower zone consolidation.

Computed tomography thorax was done which was suggestive of right middle lobe and left lingular lobe consolidation.

Bronchoscopy was normal except for mucopurulent secretions oozing out from left lingular lobe bronchus, which were aspirated and sent for AFB direct smear which was negative, CBNAAT was negative, and cytology was negative for malignant cells. A culture and sensitivity report was suggestive of growth of S. paucimobilis which was sensitive to meropenem, third-generation cephalosporins, fluoroquinolones, and aminoglycosides.

Hence, the patient was given injection meropenem and injection amikacin for 10 days. After 10 days, the patient's repeat Chest X-ray PA view was done which shows a significant resolution, total leukocyte counts were reduced to 10,400 cells/mm3, and there was a significant clinical improvement. The patient was discharged on tablet levofloxacin 750 mg once a day for 7 days [Figure 1],[Figure 2],[Figure 3],[Figure 4].
Figure 1: Suggestive of bilateral lower zone consolidation

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Figure 2: Computed tomography thorax suggestive of right middle lobe and left lingular lobe consolidation

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Figure 3: Mucopurulent secretions oozing out from left lingular lobe bronchus

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Figure 4: Chest X-ray showing significant resolution after 10 days of antibiotic treatment

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  Discussion Top


NRP is a common diagnostic challenge encountered in day-to-day practice. The term NRP has been used to refer to “Persistence of radiological abnormalities beyond the expected time of course.” NRP is a clinical syndrome, in which focal infiltrates begin with some clinical association of acute pulmonary infection, and despite a minimum of 10 days of antibiotic therapy, patients either do not improve or worsen, or radiographic opacities fail to resolve within 12 weeks. Streptococcus pneumoniae, Legionella, Staphylococcus aureus, and Pseudomonas aeruginosa are common organisms responsible for nonresolution. Noninfectious causes include drug-induced pneumonitis, adult respiratory distress syndrome, pulmonary thromboembolism, carcinomatous lymphangitis, and cardiogenic pulmonary edema. There are only a few literature reviews available which are concerning bacteremia associated with S. paucimobilis.

We present a case report of nonresolving consolidation due to an uncommon low virulence organism S. paucimobilis which is reported scarcely in the literature. Most of the cases reported are in immunocompromised hosts but also can infect healthy people.

S. paucimobilis is a strictly aerobic, nonspore-forming, nonfermentative Gram-negative bacillusin both environmental and hospital settings.[1] It is characterized by catalase and oxidase activity, yellow pigment production, and slow motility with single polar flagellum, thus paucimobilis.[1] It is most commonly from hospital-acquired infections which are associated with catheters, urinary tract infections, soft-tissue infections, and very rarely pneumonia. Organism can be cultured on a variety of nonselective media including blood and chocolate agar but not on MacConkey agar or media selective for enterobacteria.

Unlike other Gram-negative rods, it lacks lipopolysaccharide in its outer capsule; instead, it possesses at least two different kinds of sphingolipids (where its name derives from). S. paucimobilis is widely distributed in natural environment as well as hospital settings. The first case of this bacterial infection was reported in 1979 in an infectious leg ulcer patient.[2] The organism can grow very easily in hospital chemicals/fluids and equipment.[3],[4],[5],[6],[7] Community-acquired infections by S. paucimobilis are also reported but lesser in number.

S. paucimobilis-associated clinical syndromes include primary bacteremia, intravascular catheter-related infection, biliary and urinary tract infections, ventilator-associated pneumonia, peritoneal dialysis associated peritonitis, meningitis, and diarrheal diseases.[8],[9],[10],[11],[12],[13],[14],[15],[16]


  Conclusion Top


Most of the S. paucimobilis infections reported in the literature have been health care associated, but contrary to the recent publications, we revealed a community-acquired infection.

S. paucimobilis grows easily in hospital equipment. Due to low virulent features of the bacteria, it is not associated with serious life-threatening infections, but with increasing number of case reports, it should be considered as an emerging pathogen in community-acquired infection and not just a contaminant of hospital setup.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bhatia R, Tomar J. Sphingomonas paucimobilis-an emerging pathogen, Int J Contemp Pediatr. 2016;3:1123-5.  Back to cited text no. 1
    
2.
Peel MM, Davis JM, Armstrong WL, Wilson JR, Holmes B. Pseudomonas paucimobilis from a leg ulcer on a Japanese seaman. J Clin Microbiol 1979;9:561-4.  Back to cited text no. 2
    
3.
Calubiran OV, Schoch PE, Cunha BA. Pseudomonas paucimobilis bacteraemia associated with haemodialysis. J Hosp Infect 1990;15:383-8.  Back to cited text no. 3
    
4.
Faden H, Britt M, Epstein B. Sinus contamination with Pseudomonas paucimobilis: A pseudoepidemic due to contaminated irrigation fluid. Infect Control 1981;2:233-5.  Back to cited text no. 4
    
5.
Holmes B, Owen RJ, Evans A, Malnick H, Wilcox WR. Pseudomonaspaucimobilis, a new species isolated from human clinical specimens, the hospital environment, and other sources. Int J Syst Bacteriol 1977;27:133-46.  Back to cited text no. 5
    
6.
Phillips G, Fleming LW, Stewart WK, Hudson S. Pseudomonas paucimobilis contamination in haemodialysis fluid. J Hosp Infect 1991;17:70-1.  Back to cited text no. 6
    
7.
Swann RA, Foulkes SJ, Holmes B, Young JB, Mitchell RG, Reeders ST. “Agrobacterium yellow group” and Pseudomonas paucimobiliscausing peritonitis in patients receiving continuous ambulatory perito6neal dialysis. J Clin Pathol 1985;38:1293-9.  Back to cited text no. 7
    
8.
Casadevall A, Freundlich LF, Pirofski L. Septic shock caused by Pseudomonas paucimobilis. Clin Infect Dis 1992;14:784.  Back to cited text no. 8
    
9.
Crane LR, Tagle LC, Palutke WA. Outbreak of Pseudomonas paucimobilis in an intensive care facility. JAMA 1981;246:985-7.  Back to cited text no. 9
    
10.
Decker CF, Hawkins RE, Simon GL. Infections with Pseudomonas paucimobilis. Clin Infect Dis 1992;14:783-4.   Back to cited text no. 10
    
11.
Ganasathi K, Jadhav U, Belsare A. To Study the Utility of Fibreoptic Bronchoscopy in Diagnosis of Various Lung Conditions: A Study Protocol. Int J Pharm Res 2019;11:2022-25. Available from: https://doi.org/10.31838/ijpr/2019.11.04.504. [Last accessed on 2020 Mar 08].  Back to cited text no. 11
    
12.
Sharma SK, Chaubey J, Singh BK, Sharma R, Mittal A, Sharma A. Drug Resistance Patterns among Extra-Pulmonary Tuberculosis Cases in a Tertiary Care Centre in North India. Int J Tuberc Lung Dis 2017;21: 1112-7. Available from: https://doi.org/10.5588/ijtld.16.0939. [Last accessed on 2020 Mar 08].  Back to cited text no. 12
    
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Sharma T, Ghewade B, Jadhav U, Chaudhari S. Clinical Profile of Lung Cancer at Acharya Vinoba Bhave Rural Hospital. J Datta Meghe Inst Med Sci Univ 2017;12:41-4. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_21_17. [Last accessed on 2020 Mar 08].  Back to cited text no. 13
    
14.
Dhamgaye TM. In Reply: Latent TB Treatment in Pregnant Women: A Patient Perspective. Int J Tuberc Lung Dis 2020;24:1226-7. Available from: https://doi.org/10.5588/ijtld.20.0390. [Last accessed on 2020 Mar 08].  Back to cited text no. 14
    
15.
Dhamgaye TM, Bhaskaran DS. An Unusual Pulmonary Metastatic Manifestation of Gestational Choriocarcinoma: A Diagnostic Dilemma. Lung India 2017;34:490-1. Available from: https://doi.org/10.4103/lungindia.lungindia_77_14. [Last accessed on 2020 Mar 08].  Back to cited text no. 15
    
16.
Spencer LJ, Castle CD, Dingels ZV, Fox JT, Hamilton EB, Liu Z, et al. Global Injury Morbidity and Mortality from 1990 to 2017: Results from the Global Burden of Disease Study 2017. Injury Prevention 2020;26: i96–114. Available from: https://doi.org/10.1136/injuryprev-2019-043494. [Last accessed on 2020 Mar 08].  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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