Abstract

Background: Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause of opportunistic pulmonary infections, particularly in patients with Cystic Fibrosis (CF). The natural ecology of the bacteria as part of plant growth-promoting rhizosphere provides stark contrast to its infectious potential. Its preponderance as a nosocomial pathogen may be due to its ability to survive in antiseptic solutions, contaminate equipments and intrinsic antimicrobial resistance.

Case: An elderly, diabetic male was evaluated for hemoptysis, fever and cough. Chest computed tomography showed a thick walled cavity in the left lung and hilar lymphadenopathy. Sputum examination showed Gram negative bacilli and no acid fast bacilli. Sputum culture yielded growth of non-fermentative Gram negative bacilli on two occasions, but blood culture was sterile. The isolate was identified as B. cepacia by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The patient’s general condition remained poor and in spite of initiation of antibiotics, the patient expired after an episode of massive hemoptysis.

Conclusion: This report raises concerns regarding the spread and severity of B. cepacia infection in non-compromised patients in the community and the need to suspect and identify it. Since the organism is inherently resistant to antipseudomonal penicillins, aminoglycosides and polymyxin B, differentiation from Pseudomonas spp. and determining antimicrobial susceptibility is paramount for treatment.

Keywords: Burkholderia cepacia pneumonia, non-cystic fibrosis, antipseudomonal penicillins, antimicrobial, B. cepacia, Pseudomonas spp.

Graphical Abstract