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Bronchiectasis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
A 29-year-old man with bronchiectasis secondary to congenital agammaglobulinaemia presents with an exacerbation. He has been treated extensively in the past and is on nebulized tobramycin and oral azithromycin. A pan-resistant Burkholderia multivorans is isolated from sputum. Empirically, treatment is commenced with ceftazidime/avibactam together with aztreonam, whilst awaiting synergy testing results from a reference laboratory.
Cystic fibrosis respiratory microbiota: unraveling complexity to inform clinical practice
Published in Expert Review of Respiratory Medicine, 2018
Lindsay J. Caverly, John J. LiPuma
Another factor likely contributing to the lack of identification of a consistent change in respiratory microbiota with pulmonary exacerbation is the interpatient differences observed in baseline bacterial communities. This was demonstrated in an early study by Carmody et al. [27], in which 34 paired baseline and exacerbation sputum samples from 28 adults with CF were analyzed. Significant interpatient differences in changes in respiratory microbiota from baseline to exacerbation were observed. For example, communities dominated by Pseudomonas had different changes in diversity between baseline and exacerbation than communities dominated by other species [27]. Communities dominated by Pseudomonas have been shown to have a decrease in relative abundance of Pseudomonas between baseline and exacerbation samples [27], whereas an increase in the abundance of Burkholderiamultivorans (using genus-specific qPCR) has been identified prior to exacerbation onset in a separate study [48]. These data demonstrate that the dominant CF pathogen is a relevant variable in considering changes in respiratory microbiota between baseline and exacerbation.
An unusual case of mediastinal lymphadenopathy and fever
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2019
Kevin J. Solverson, Wilson Chan, Alain Tremblay
Gram stain of the tissue done in microbiology was also negative for organisms, but heavy neutrophils were noted. At 24 hours of incubation, tiny, nondescript colonies of Gram-negative bacilli were present on the blood agar plate in scant amounts. The oxidase reaction was positive. There was insufficient growth for identification on day 1, and the colonies were subcultured. The Vitek MS (bioMerieux, Marcy-l’Étoile, France), a mass spectrometry microbial identification platform, returned the identification as a high confidence (99.9%) 50/50 split between Burkholderia multivorans and B. cepacia, both members of the B. cepacia complex. By routine laboratory protocol, biochemical confirmation was performed on the Vitek2 platform (bioMerieux) using the GNI card. The Vitek2 determined the identification to be Burkholderia pseudomallei, with 90% confidence. The isolate was taped to prevent further exposures to laboratory staff and sent urgently to the provincial public health laboratory for molecular confirmation. Using a species-specific PCR distributed by the Public Health Agency of Canada, the identification was confirmed as B. pseudomallei, and confirmed by the National Microbiology Laboratory (NML) of Canada using a combination of molecular assays and biochemical characteristics. Susceptibility testing done through the public health laboratory showed that the isolate was resistant to gentamicin, but susceptible to trimethoprim-methoxazole, ceftazidime, amoxicillin-clavulanate, doxycycline and imipenem. Typing was done using multi-locus sequence typing at the Canadian National Microbiology Laboratory.