A successful antimicrobial regime for Chromobacterium violaceum induced bacteremia
© Campbell et al.; licensee BioMed Central Ltd. 2013
Received: 18 February 2011
Accepted: 3 January 2013
Published: 4 January 2013
Chromobacterium violaceum is a proteobacterium found in soil and water in tropical regions. The organism rarely causes infection in humans, yet can cause a severe systemic infection by entering the bloodstream via an open wound.
We recently identified a case of severe bacteremia caused by Chromobacterium violaceum at the Hospital for Tropical Diseases (HTD) in Ho Chi Minh City, Vietnam. Here, we describe how rapid microbiological identification and a combination of antimicrobials was used to successfully treat this life threatening infection in a four-year-old child.
This case shows the need for rapid diagnosis when there is the suspicion of a puncture wound contaminated with water and soil in tropical regions. We suggest that the aggressive antimicrobial combination used here is considered when this infection is suspected.
Chromobacterium violaceum is a Gram-negative facultatively anaerobic proteobacterium that can be isolated from water and soil in tropical and sub-tropical regions . The organism rarely infects humans; yet, occasionally, the organism can establish a severe systemic infection by entering the bloodstream via an open wound. There has been a recent surge in interest in human Chromobacterium violaceum infections in South East Asia, potentially as a consequence of increased reporting and awareness . In 2008 we documented the first ever case in Ho Chi Minh City . Since this primary case, three more infections have been observed in the city hospitals. Due to the rapid progression of human Chromobacterium violaceum infections, a systemic infection with this bacterium is typically fatal and no efficacious treatment regimes have ever been described. Here we report a case of Chromobacterium violaceum in Ho Chi Minh City that was successfully treated with a combination of antimicrobials.
A four-year-old HIV negative male presented at the Hospital for Tropical Diseases in Ho Chi Minh City with a puncture wound on his right ankle. He was admitted and had a three-day history of fever, fatigue, vomiting and anorexia. He had previously been diagnosed with pulmonary Tuberculosis when three years old and had previously been taking a combination of rifampicin, 4-aminosalicylic acid and ethambutol for eight months. He had no other underlying diseases. On admission he had a pulse rate of 180 beats/minute, low blood pressure, a respiration rate of 57 breaths/minute, crackling chest sounds and pale sclera. The cervical lymph nodes were swollen, measuring 2 cm in diameter. He had displayed evidence of hepatomegaly, but was not jaundiced and had two small blisters on the abdomen.
Hematology results over Chromobacterium violaceum infection
C-reactive protein (mg/l)
Blood chemistry results of a Chromobacterium violaceum infection on admission
Chemical test (normal range)
Sodium (135–145 mmol/l)
Potassium (3.5-5.0 mmol/l)
Chlorine (98–106 mmol/l)
Calcium (2.15-2.6 mmol/l)
Creatinine (53–130 μmol/l)
SGPT (0–40 Ul/l)
GGT (7–50 UI/l)
Lactate IV (0.6-2.4 mmol/l)
The first reported human infection with Chromobacterium violaceum was in Malaysia in 1927, and less than 100 cases have been described since [7–10]. This case in Ho Chi Minh City shows the need for rapid diagnosis when there is the suspicion of a puncture wound contaminated with water and soil in tropical regions. A high C reactive protein, despite having a low specificity, was used as an indicator of severe sepsis. The subsequent early blood culture for isolation, identification and antimicrobial susceptibility were used to diagnose this infection and are essential for initiating early antimicrobial therapy. Although this type of infection is rare it should be factored into the differential diagnosis with Burkholderia spp., Aeromonas spp. and Pseudomonas spp. in tropical and sub-tropical regions, as a substantial delay in treatment can lead to rapid decline and death. We hope that this communication will continue to raise the awareness of this potentially fatal infection and we suggest that the aggressive antimicrobial combination used here is considered when this infection is suspected.
Written informed consent was obtained from the patient's parent for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
We thank the directors and the clinical and microbiology staff of the Hospital for Tropical Diseases, Ho Chi Minh City, for their support in this study. This work was supported by The Wellcome Trust of Great Britain, Euston Road, London, United Kingdom. SB is funded by the OAK foundation through Oxford University.
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