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ELIZABETHKIN GIA MENINGOSEPTICA Dr.T.V.Rao MD 4/6/16 Dr.T.V.Rao MD 1
ELIZABETHKIN
GIA
MENINGOSEPTICA
Dr.T.V.Rao MD
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Elizabethkingia meningoseptica • Elizabethkingia 4/6/16 Dr.T.V.Rao MD 2
Elizabethkingia
meningoseptica
• Elizabethkingia
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meningoseptica is a gram-negative rod- shaped bacterium widely distributed in nature (e.g. fresh water, salt water, or soil). It may be normally present in fish and frogs but is

History of Elizabethkingia • In 1959, the American bacteriologist Elizabeth O. King 4/6/16 Dr.T.V.Rao MD 3
History of Elizabethkingia
• In 1959, the
American
bacteriologist
Elizabeth O. King
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(who isolated Kingella in 1960) was studying unclassified bacteria

Important Bacteria stable and adopts to Environment 4/6/16 Dr.T.V.Rao MD 4
Important Bacteria stable
and adopts to Environment
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Elizabethkingia meningoseptica has been deemed a potentially important threat to patients in critical care areas because of its multidrug-resistant phenotype and its ability to adapt to

Elizabethkingia is found in the environment • Commonly found in the environment, particularly in soil and
Elizabethkingia is found in the
environment
• Commonly found in
the environment,
particularly in soil
and water,
Elizabethkingia rarely
causes disease in
otherwise healthy
individuals.
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Uncommon pathogen and Respiratory colonizer • Elizabethkingia are bacteria that are rarely reported to cause illness
Uncommon pathogen and
Respiratory colonizer
• Elizabethkingia are
bacteria that are
rarely reported to
cause illness in
humans, and are
uncommon
colonizers of the
respiratory tract
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Present outbreak 4/6/16 Dr.T.V.Rao MD 7
Present outbreak
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In this outbreak, the bacteria primarily infect older adults and those who have serious underlying health conditions. The infection typically presents as septicaemia and can be deadly if not

General Characteristics E. • E. meningoseptica meningoseptica 4/6/16 Dr.T.V.Rao MD 8
General Characteristics E.
E.
meningoseptica
meningoseptica
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is a species of Gram-negative, obligate aerobic, non- fastidious, non- spore forming, nonfermentative ; nonmotile; slender; slightly

Elizabethkingia • Elizabethkingia is a genus of bacteria commonly found in the environment worldwide and has
Elizabethkingia
Elizabethkingia
is a genus of
bacteria
commonly found
in the
environment
worldwide and
has been
detected in soil,
river water and
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i

Elizabethkingia meningoseptica on (a) sheep blood agar and (b) MacConkey agar 4/6/16 Dr.T.V.Rao MD 10
Elizabethkingia meningoseptica on (a)
sheep blood agar and (b) MacConkey
agar
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Magnified view of the Colonies ofElizabethkingia anophelis • Three individual Elizabethkingia anophelis colonies growing next to
Magnified view of the
Colonies ofElizabethkingia
anophelis
• Three individual
Elizabethkingia
anophelis colonies
growing next to
each other on
blood agar. Photo
courtesy CDC
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Biochemically reacting 4/6/16 Dr.T.V.Rao MD 12
Biochemically reacting
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Catalase positive, oxidase positive, and indole-positive, OF glucose ox+/F-, urease negative (contrast E. miricola which is urease positive), mannitol positive, non-nitrate-reducing saprophytic bacilli. It is gelatinase, esculin, ONPG & DNAse positive. Chryseobacteria (Flavobacteria) are in general indole positive in

Growth Characters • E. meningoseptica grows well in regular incubators on blood agar and chocolate agar.
Growth Characters
E.
meningoseptica
grows well in regular
incubators on blood
agar and chocolate
agar. Colonies are
very pale yellow and
may not be easily
evident at 24 hours.
E.
meningoseptica
strains either are not
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pigmented or
produce a weak
yellow nondiffusible
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Infection 4/6/16 Dr.T.V.Rao MD 14
Infection
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E. meningoseptica predominantly causes outbreaks of meningitis in premature new- borns and infants in neonatal intensive care units of underdevelo ed

Transmission and Sources of the Infection 4/6/16 Dr.T.V.Rao MD 15
Transmission and
Sources of the Infection
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Neonatal infections due to C. meningosepticum could be through vertical transmission; however, no data about this kind of transmission of the organism is available. As many interventions (endotracheal intubation, central and peripheral intravascular

Can be a nosocomial Infection • Majority of the C. meningosepticum infections reported have been in
Can be a nosocomial
Infection
• Majority of the C.
meningosepticum
infections reported
have been in NICUs,
the infections of
these neonates are
often considered as
nosocomial
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Infection

Some of the outbreaks have been linked to sources like contaminated lipid stock bottles, contaminated venous catheter lines and nutritional solution, and tap water. The bacterium is also a rare cause of nosocomial pneumonia, endocarditis, postoperative bacteremia, and meningitis in immunocompromised

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Infection 4/6/16 Dr.T.V.Rao MD 18
Infection
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Only recently has it also been found to cause soft tissue infection and sepsis in the immunocompeten t and in a case of

Current methods to identify • State clinical microbiology laboratories can characterize the isolates using pulsed-field gel
Current methods to identify
• State clinical microbiology laboratories
can characterize the isolates using
pulsed-field gel electrophoresis, a
method that can identify the
Elizabethkingia genus correctly. Isolates
sent to CDC's Special Bacteriology
Reference Laboratory are confirmed as
the species E anophelis on the basis of
the pathogen's protein profile, acquired
using the mass spectrometry method
MALDI-ToF (matrix-assisted laser
desorption/ionization time-of-flight),
and optical mapping of the bacterial
genome.
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Treatment and Drug resistant patterns • This bacterium is usually multiresistant to antibiotics typically prescribed for
Treatment and Drug resistant
patterns
• This bacterium is usually
multiresistant to
antibiotics typically
prescribed for treating
gram-negative bacterial
infections, including
extended-spectrum beta-
lactam agents (due to
production by most strains
of two beta lactamases:
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one ESBL and one Class B Carbapenem-Hydrolyzing metallolactamase), 4/6/16 Dr.T.V.Rao MD

6 day old Blood agar growth of Elizabethkingia meningioseptica • 6 day old Blood agar growth
6 day old Blood agar growth of
Elizabethkingia meningioseptica
• 6 day old Blood agar growth of
Elizabethkingia meningioseptica
with 5ug vancomycin (with a
zone of clearing) and 10 ug
colistin disks. This strain did not
produce the flexirubin pigment.
Like Burkholderia cepacia this
organism can be Colistin
resistant and partially
Vancomycin sensitive
• Copy right of the picture and protocol permission is granted to
copy, distribute and/or modify this document under the terms of
the GNU Free Documentation License, Version 1.2 or any later
version published by the Free Software Foundation; with no
Invariant Sections, no Front-Cover Texts, and no Back-Cover Texts.
A copy of the license is included in the section entitled GNU Free
Documentation License.
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Choosing the Antibiotics 4/6/16 Dr.T.V.Rao MD 22
Choosing the Antibiotics
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Though vancomycin has been used in the past, its high MIC (16 µg/ml) has led to a search for alternatives, especially for meningitis. Presently ciprofloxacin, minocycline, trimetho rim-

• Hypoalbumine Predictors of poor outcome mia, increased 4/6/16 Dr.T.V.Rao MD 23
• Hypoalbumine
Predictors of poor outcome
mia, increased
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pulse rate at the onset of infection, and central venous line infection were associated with a poor

Trends in management of outbreaks 4/6/16 Dr.T.V.Rao MD 24
Trends in management of
outbreaks
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CDC and the affected states continue to work toward managing the ongoing outbreak. The unexpected number of infections with this unusual pathogen reminds us of the importance of new and emerging technologies, such as advanced molecular detection and

. Infection Control Interventions • Outbreaks of Gram-negative bacterial infections are usually due to transient carriage
. Infection Control Interventions
• Outbreaks of Gram-negative
bacterial infections are usually
due to transient carriage of
the organisms on the hands of
healthcare workers .
Susceptible patients may
become colonized after
acquiring the organism from
the healthcare worker, and
infection may or may not
develop.
• Hand washing by Health care workers
potentially stops spread
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The Medical Profession Need more awareness on the emerging infection

In addition to reinforcement of standard infection control measures, actions that have successfully terminated E. meningoseptica outbreaks include pre- emptive contact isolation, systematic investigations to identify the source of the bacterium and thorough cleaning of equipment and environmental surfaces. As the clinical complexity and incidence of E. meningoseptica infections increase, there is a need for heightened awareness of the

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Resources and References

CDC on Elizabethkingia Medscape Infectious diseases WIKIPEDIA ON LINE RESOURCE

Review Article Elizabethkingia meningosepticum (Chryseobacterium meningosepticum) Infections in Children Mehmet Ceyhan and Melda Celik International Journal of Pediatrics Volume 2011 (2011), Article ID 215237, 7 pages

Program Created by Dr.T.V.Rao MD for Medical and Paramedical Professionals for awareness on the emerging trends on Elizabethkingia meningoseptica

Email

doctortvrao@gmail.com