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Communications to the Editor |

Bacteremic Community-Acquired Pneumonia in an Immunocompetent Adult Due to Burkholderia cepacia FREE TO VIEW

Grant W. Waterer, MBBS; Carol B. Jones, BSN; Richard G. Wunderink, MD, FCCP
Author and Funding Information

Methodist Healthcare Memphis, TN

Correspondence to: Grant W. Waterer, MBBS, Pulmonary Host Defense Fellow, Methodist Healthcare, 1265 Union Ave, 501 Crews Wing, Memphis, TN 38104-2499; e-mail: waterer@ ibm.net Dr. Waterer has been supported by a grant from the Methodist-LeBonheur Healthcare Foundation and by the Athelstan and Amy Saw Medical Research Fellowship from the University of Western Australia.



Chest. 1999;116(6):1842-1843. doi:10.1378/chest.116.6.1842
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To the Editor:

We report what we believe is the first case of community-acquired pneumonia (CAP) due to Burkholderia cepacia (for-merly Pseudomonas cepacia) described in an immunocompetent adult. Although well recognized as an opportunistic pulmonary pathogen, particularly in patients with cystic fibrosis, the only prior report of pneumonia due to B cepacia in an immunocompetent host occurred in a 14-year-old boy.1Although no underlying pulmonary disease was apparent, the possibility of underlying cystic fibrosis was raised.2

A 32-year-old African-American man presented to our hospital with a 1-week history of fever, cough productive of thick yellow-green sputum, dyspnea, nausea, and vomiting. Mild hypertension, treated with fosinopril, was the patient’s only prior medical condition, and he denied alcohol or cigarette consumption. He admitted to occasional marijuana use but denied any other illicit drug use. He was employed as a cook and lived with his wife and child. There was no family history of any pulmonary illness, and he had had no recent contact with anyone with any pulmonary illness.

On examination, the patient had a temperature of 38.4°C, a heart rate of 90 beats per minute, a respiratory rate of 22 breaths per minute, and a BP of 110/68 mm Hg. Oxygen saturation was 97% by oximetry. He had no clubbing but had coarse crackles at the left posterior lung base on chest auscultation. There were no other abnormal findings. Laboratory studies showed a total WBC count of 25 × 106 cells/L, with normal levels of electrolytes, and normal results of renal and hepatic function tests. A chest roentgenogram showed consolidation in the left lower lobe.

The patient consented to an outpatient pharmaceutical trial comparing two quinolone antibiotics. A sputum culture, including a specific culture for Legionella species, did not grow any pathogens. Results of a Legionella urinary antigen test were negative. Throat and nasal swabs were also negative for Chlamydia and Mycoplasma species. Results of paired acute and convalescent serology for Legionella pneumophila (serogroups 1 to 6), Chlamydia pneumoniae, Chlamydia psitacci, Chlamydia trachomatis, and Mycoplasma pneumoniae all showed no evidence of infection. The single blood culture grew an unusual form of B cepacia that was fully sensitive to ofloxacin (including both study drugs), cefotaxime, and piperacillin.

The recovery of the patient was uneventful, and he resumed normal activities, including competitive basketball, within 14 days of starting antibiotics. The results of a physical examination and spirometry 1 month after starting therapy were completely normal.

In the 6 months preceding this patient’s presentation, only one other isolate of B cepacia was cultured at our hospital. This isolate was resistant to ofloxacin, cefotaxime, and piperacillin. On the basis of the scarcity of cultures and the marked differences in antibiotic sensitivities between the two isolates, we are confident that the positive result of the culture was not due to labora-tory contamination. The absence of any other microbiological diagnosis despite extensive testing also supports the identity of the pathogen as B cepacia.

There is no evidence of cystic fibrosis or any other chronic lung disease in our patient. He had no known exposure to any source of B cepacia, and the fact that the strain was unusually sensitive to drugs is evidence against him having acquired it from someone with chronic lung disease. B cepacia was first identified in agricultural produce,3so, inasmuch as one of the patient’s job responsibilities is food preparation, he may have acquired it at work. Concern has been raised about the potential use of B cepacia as a biopesticide in the agricultural industry,4 but we have been unable to confirm whether it is being used in our region.

In conclusion, we have reported a case of bacteremic CAP due to B cepacia in an immunocompetent host who has no underlying lung disease. Unlike most cases involving B cepacia, the most likely source of this infection is from a nonhospital environment, probably from agricultural produce.

References

Pujol, M, Corbell, X, Carratala, J, et al (1992) Community-acquired bacteremicPseudomonas cepaciapneumonia in an immunocompetent host.Clin Infect Dis15,887-888. [PubMed] [CrossRef]
 
Cohen, MS, Knowles, MR, Yankaskas, JR Infection due toPseudomonas cepacia.Clin Infect Dis1993;17,291-292. [PubMed]
 
Burkholder, WH Sour skin, a bacterial rot of onion bulbs.Phytopathology1950;40,115-117
 
Holmes, A, Govan, J, Goldstein, R Agricultural use ofBurkholderia (Pseudomonas) cepacia: a threat to human health?Emerg Infect Dis1998;4,221-227. [PubMed]
 

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References

Pujol, M, Corbell, X, Carratala, J, et al (1992) Community-acquired bacteremicPseudomonas cepaciapneumonia in an immunocompetent host.Clin Infect Dis15,887-888. [PubMed] [CrossRef]
 
Cohen, MS, Knowles, MR, Yankaskas, JR Infection due toPseudomonas cepacia.Clin Infect Dis1993;17,291-292. [PubMed]
 
Burkholder, WH Sour skin, a bacterial rot of onion bulbs.Phytopathology1950;40,115-117
 
Holmes, A, Govan, J, Goldstein, R Agricultural use ofBurkholderia (Pseudomonas) cepacia: a threat to human health?Emerg Infect Dis1998;4,221-227. [PubMed]
 
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