Journal Article

Recurrent <i>Achromobacter xylosoxidans</i> Bacteremia Associated with Persistent Lymph Node Infection in a Patient with Hyper-Immunoglobulin M Syndrome

Jörn-Hendrik Weitkamp, Yi-Wei Tang, David W. Haas, Narinder K. Midha and James E. Crowe

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 31, issue 5, pages 1183-1187
Published in print November 2000 | ISSN: 1058-4838
Published online November 2000 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/317461
Recurrent Achromobacter xylosoxidans Bacteremia Associated with Persistent Lymph Node Infection in a Patient with Hyper-Immunoglobulin M Syndrome

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Achromobacter xylosoxidans (formerly Alcaligenes xylosoxidans) is a rare but important cause of bacteremia in immunocompromised patients, and strains are usually multiply resistant to antimicrobial therapy. We report an immunocompromised patient with hyper-immunoglobulin M syndrome who suffered from 14 documented episodes of A. xylosoxidans bacteremia. Each episode was treated and resulted in rapid clinical improvement, with blood cultures testing negative for bacteria. Between episodes, A. xylosoxidans was isolated from an excised right axillary lymph node, whereas the culture of the central venous catheter, removed at the same time, was negative. Multiple cultures from sputum, stool, and urine samples, as well as from gastrointestinal biopsies or environmental sources, were negative. Results from antibiotic sensitivity testing and pulsed-field gel electrophoresis suggested that a single strain of A. xylosoxidans caused the recurrent bacteremias in this patient; this strain originated from persistently infected lymph nodes. Lymphoid hyperplasia is a prominent characteristic of hyper-IgM syndrome and may serve as a source of bacteremia with low-pathogenicity organisms.

Journal Article.  3225 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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