A rare opportunistic bloodstream infection elizabethkingia meningoseptica in an immunocompromised patient

S.Suganya1*, T. Lucy Grace2, Esthar Rani3

1Nursing Supervisor-Infection Control Nurse, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

3Nursing Superintendent, Kauvery Hospital, Tennur, Trichy, Tamil Nadu

*Correspondence

Abstract

Elizabethkingia meningoseptica is a rare, opportunistic, multidrug-resistant gram-negative bacillus associated with severe healthcare-associated infections, particularly among immunocompromised patients. We report a case of Elizabethkingia meningoseptica bloodstream infection in a 26-year-old female with newly diagnosed Acute Promyelocytic Leukemia (APL), complicated by a non-healing right leg ulcer, cellulitis, prolonged hospitalization, multiple invasive procedures, and persistent fever.
Key words: Elizabethkingia meningoseptica; Gram-negative bacillus; Acute Promyelocytic Leukemia (APL)

Introduction

Elizabethkingia meningoseptica is an aerobic, non-fermenting, gram-negative bacillus widely distributed in the environment, particularly in water sources and hospital settings. It is known to cause infections in neonates, critically ill patients, and immunocompromised individuals. The organism is associated with high morbidity and mortality due to its intrinsic resistance to multiple antibiotics and its ability to survive in healthcare environments.

Case Presentation

A 26-year-old female was admitted with complaints of a non-healing ulcer over the right leg for 10 days, associated with swelling, pain, and blister formation. She had undergone superficial wound debridement at an outside hospital and was referred to our center due to bicytopenia with leukocytosis Further evaluation confirmed Acute Promyelocytic Leukemia (APL) with cellulitis and a non-healing infected ulcer of the right lower limb. Initial laboratory investigations showed a white blood cell count of 20,070/cumm and platelet count of 2,500/cumm. Broad-spectrum antibiotic therapy with Meropenem was initiated, and the patient was admitted to the Critical Care Unit.

During hospitalization, a central venous catheter (CVC) was inserted, multiple blood product transfusions were administered, and chemotherapy was initiated. The patient’s clinical course was complicated by persistent fever, worsening lower limb infection, pulmonary edema, and progressive ischemic changes requiring repeated wound debridement and eventual right above-knee amputation. On Day 8 of hospitalization, blood cultures grew Candida species, for which Caspofungin therapy was started. Despite antifungal treatment, the patient continued to experience persistent fever and tachycardia.

On Day 13, blood cultures were obtained from the central venous catheter. On Day 14, the CVC blood culture grew Elizabethkingia meningoseptica. The patient remained febrile with ongoing hematological abnormalities. Subsequently, all previous antibiotics were discontinued, and Magnex Forte was initiated as per Infectious Disease recommendations. Repeat cultures were sent; however, due to persistent fever and clinical deterioration, the patient was transferred back to the Critical Care Unit.

Patient Outcome

Despite appropriate supportive care, the patient condition deteriorated because of severe underlying disease and persistent bloodstream and soft tissue infection. The family opted for discharge against medical advice.

Discussion

Elizabethkingia meningoseptica is increasingly recognized as a cause of healthcare-associated bloodstream infections among immunocompromised patients. Risk factors in this patient included:

  • Acute Promyelocytic Leukemia with severe immunosuppression.
  • Prolonged hospitalization.
  • Central venous catheter placement.
  • Multiple blood product transfusions.
  • Broad-spectrum antibiotic exposure.
  • Persistent soft tissue infection and repeated surgical procedures.
  • Intensive care unit stay.

The organism can colonize hospital water systems, biofilms, and indwelling devices, making eradication difficult. Treatment should always be guided by antimicrobial susceptibility testing.

Potential preventive measures include:

  • Strict hand hygiene compliance.
  • Adherence to central line insertion and maintenance bundles.
  • Regular surveillance of water sources and equipment.
  • Prompt removal of unnecessary invasive devices.
  • Environmental cleaning and disinfection.
  • Antimicrobial stewardship practices.
  • Early investigation of persistent fever in immunocompromised patients.

Conclusion

Maintain a high index of suspicion for unusual pathogens in immunocompromised patients with persistent fever. Ensure strict hand hygiene, central line bundles, environmental cleaning, surveillance of hospital water systems, prompt removal of unnecessary invasive devices, early culture sampling, antimicrobial stewardship, and multidisciplinary management. Early recognition and infection prevention remain the most effective strategies to reduce morbidity and improve future patient outcomes.

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment