ELIZABETHKIN

GIA

MENINGOSEPTICA
Dr.T.V.Rao MD

4/6/16

Dr.T.V.Rao MD

Elizabethkingia
meningoseptica
Elizabethkingia

meningoseptica is a
gram-negative rodshaped bacterium
widely distributed in
nature (e.g. fresh
water, salt water, or
soil). It may be
normally present in
fish and frogs but is
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Dr.T.V.Rao MD

History of Elizabethkingia
In

1959, the
American
bacteriologist
Elizabeth O. King
(who isolated
Kingella in 1960)
was studying
unclassified
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Dr.T.V.Rao MD

Important Bacteria stable

and adopts to Environment
Elizabethkingia

meningoseptica has
been deemed a
potentially important
threat to patients in
critical care areas
because of its
multidrug-resistant
phenotype and its
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Dr.T.V.Rao MD

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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Dr.T.V.Rao MD

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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Dr.T.V.Rao MD

Present outbreak
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
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Dr.T.V.Rao MD

E.
General Characteristics
E.
meningoseptica
meningoseptica

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is a species of
Gram-negative,
obligate
aerobic, nonfastidious, nonspore forming,
nonfermentative
; nonmotile;
slender; slightly

Dr.T.V.Rao MD

Elizabethkingia
Elizabethkingia

4/6/16

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

Dr.T.V.Rao MD

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
each other on
blood agar. Photo
courtesy CDC

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Biochemically reacting
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
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Dr.T.V.Rao MD
general indole positive in

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meningoseptica
Growth Characters
grows well in regular
E.

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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
pigmented or
produce a weak
Dr.T.V.Rao MD
yellow nondiffusible 13

Infection
E.

meningoseptica
predominantly
causes outbreaks of
meningitis in
premature newborns and infants in
neonatal intensive
care units of
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Dr.T.V.Rao MD

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Transmission and
Sources of the Infection

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
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Dr.T.V.Rao MD
intravascular

15

Can be a nosocomial
Infection

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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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Some

Infection

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
Only

recently has
it also been
found to cause
soft tissue
infection and
sepsis in the
immunocompeten
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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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Dr.T.V.Rao MD

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Treatment and Drug resistant

patterns
This bacterium is usually

multiresistant to
antibiotics typically
prescribed for treating
gram-negative bacterial
infections, including
extended-spectrum betalactam agents (due to
production by most strains
of two beta lactamases:
one ESBL and one Class B
Carbapenem-Hydrolyzing
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Dr.T.V.Rao MD
metallolactamase),

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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

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Dr.T.V.Rao MD

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Choosing the Antibiotics

Though

vancomycin
has been used in the
past, its high MIC (16
g/ml) has led to a
search for
alternatives,
especially for
meningitis. Presently
ciprofloxacin,
minocycline,
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Dr.T.V.Rao MD

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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

Dr.T.V.Rao MD

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 CDC

Trends in management of
outbreaks

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
4/6/16 as advanced
molecular detection and

Dr.T.V.Rao MD

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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 preemptive 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
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Dr.T.V.Rao MD

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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

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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

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