Chest Infections: Student/Resident Case Report Poster - Chest Infections II |

Don’t Let the Burk Holderia You Back! FREE TO VIEW

Krayton Blower, DO; Holly Keyt, MD
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University of Texas Health Science Center, San Antonio, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):178A. doi:10.1016/j.chest.2016.08.187
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SESSION TITLE: Student/Resident Case Report Poster - Chest Infections II

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Infection with Burkholderia cepacia complex (BCC) is considered a relative contraindication to lung transplantation in cystic fibrosis (CF) patients due to poor survival rates after transplant. However BCC is comprised of approximately 20 distinct species and not all confer the same risk. Several studies demonstrate that patients infected with some of the non-cenocepacia Burkholderia species have similar outcomes compared to uninfected individuals. There is a paucity of data regarding outcomes in patients with B. seminalis. We present the first documented case of a patient with a chronic B. seminalis infection undergoing lung transplant.

CASE PRESENTATION: The patient is a 34-year-old male with a history of CF complicated by pancreatic insufficiency and diabetes, who was referred for transplant evaluation for progressive decline in FEV1 and recurrent CF exacerbations. He was listed for transplant until BCC was isolated from the sputum and he was placed on hold. Testing at the reference lab in Michigan confirmed the species to be B. seminalis. The patient was re-activated and underwent successful lung transplant several months later. He was treated perioperatively with broad-spectrum antibiotics including inhaled tobramycin. He is now 4 months post-transplant and remains stable without signs of rejection or serious illness though his cultures continue to grow BCC.

DISCUSSION: BCC is a feared infection for CF patients. One study showed a 29% one year survival after lung transplant for patients with known BCC infection compared to 76% without infection. The main complication is sepsis in the infected population. This case demonstrates that B. seminalis may be among the non-cenocepacia species that do not threaten post-transplant survival. There is no agreed upon strategy for Burkholderia eradication in asymptomatic patients.

CONCLUSIONS: As the transplant community gains experience with CF patients infected with Burkholderia, it is important to continue documenting outcomes with the various species to add to the growing body of literature signaling that infection with non-cenocepaica BCC may not be a contraindication to transplant. It is imperative that any BCC that is identified in a CF patient be sent for accurate genotyping.

Reference #1: Aris et. al. “Lung Transplantation for Cystic Fibrosis Patients with Burkholderia cepacia Complex”, American Journal of Respiratory and Critical Care Medicine, 2001. 164(11); 2102-2106.

Reference #2: Martinucci et. al. “Accurate identification of members of the Burkholderia cepacia complex in cystic fibrosis sputum.” Letters in Applied Microbiology 2015. 62: 221-229.

Reference #3: Perrot et al. Twenty-year experience of lung transplantation at a single center: Influence of recipient diagnosis on long-term survival. Journal of Thoracic and Cardiovascular Surgery 2004. 125(5):1493.

DISCLOSURE: The following authors have nothing to disclose: Krayton Blower, Holly Keyt

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