RGUHS Nat. J. Pub. Heal. Sci Vol: 14 Issue: 1 eISSN: pISSN
1Emeritus Professor of Medicine, Faculty of Medical Sciences, KBN University, Kalaburagi, Karnataka.
*Corresponding Author:
Emeritus Professor of Medicine, Faculty of Medical Sciences, KBN University, Kalaburagi, Karnataka., Email: drpsshankar@gmail.com
Abstract
Chromobacterium violaceum is a gram-negative, motile, cocco-bacillus, which is found as a normal flora in water and soil in tropical region. It can infect humans rarely and manifest with skin lesions, sepsis and liver abscesses. It makes its entry through injured skin that comes in contact with soil or water. The condition makes its presence in the form of skin lesions that may lead to metastatic lesions leading to multi-organ failure. The organism has low virulence. Antibiotics are effective in the management of the infection.
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Introduction
Chromobacterium violaceum, a common inhabitant of soil and water, rarely causes human infection and is associated with high morbidity and mortality. Though the infection appears localized, it has a great propensity to disseminate by itself .
Aetiology
Chromobacterium violaceum is a gram-negative, motile bacteria. It is a facultative anaerobe. There are two strains which can be categorized as, pigmented and non-pigmented. The pigmented strain produces a violet, non-diffusible pigment called violacein that gives the bacterial colonies purple colour on agar medium. This pigment is an antioxidant, which is soluble in water, but insoluble in alcohol. Both strains are pathogenic.
Epidemiology
The organism is found as a saprophyte in soil and stagnant waters in tropical and sub-tropical regions. Wooley isolated the organism in a buffalo that had succumbed to a fatal infection in Philippines in 1905.1 Since the description of human infection from Malaysia by Lessler in 1927, the cases have been reported from different parts of the world including India. However, the incidence has been very infrequent. Seven cases have been reported from India in the age group varying from 8 days to 24 years. Most of the cases are neonates and children. Three cases have been reported from Udipi,2-4 one from Mangalore, Karnataka,5 one from Visakhapatanam, A.P.,6 West Bengal,7 and Chandigarh.8 The bacterium has been isolated from a wound over the scalp.9 Majority of the cases reported in the world are young adults. The infection presented as septicemia in a child.10
Pathology
Chromobacterium violaceum gains entry through broken skin exposed to the organism found in the soil and water.11 It causes abscesses in skin and liver. Its haematogenous dissemination results in septicaemia. The organism grows well on ordinary laboratory media at 35-37 oC
Clinical manifestations
Chromobacterial infection presents with fever, pustular skin eruptions, multiple liver abscesses, urinary tract infection, pneumonia, and septicaemia. There can be features of meningitis. Diarrhoea can also be present. The patient appears pale with tachycardia and tachypnoea. Mild hepatosplenomegaly is also a common occurrence. Crackles can be observed on chest examination. The condition may present with symptoms ranging from localized skin and soft tissue infection to systemic infection.
Investigations
Anaemia, and polymorphonuclear leukocytosis can be commonly observed on haematological examination. Chest radiograph can show bilateral infiltrates. The anaerobic culture of the blood and pus from pustules will show growth of organism in violet-pigmented colonies with a smell of hydrogen peroxide.
Diagnosis
Chromobacterium infection is rare. Only 150 cases have been reported worldwide. This bacterium must be considered for differential diagnosis in cases of sepsis when abraded skin is exposed to soil or stagnant waters in tropical region.
Treatment
Chromobacterium exhibits low virulence. However, it can cause fatality due to septicaemia or meningitis. The organism is sensitive to drugs like pefloxacin, ciprofloxacin, chloramphenicol, amikacin, fluoroquinolones, carbapenems, cotrimoxazole, aminoglycosides, erythromycin, imipenem, and gentamicin. Drainage of abscess may be necessary. Fatal end can be prevented with prompt treatment.
Financial support
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Conflict of interest
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Supporting Files
References
- Woolley PG. Bacillus violaceus manilae (a pathogenic organism). Bull John Hopkins Hosp 1905;16:89-93.
- Shetty M, Venkatesh A, Shenoy S, Shivananda PG. Chromobacterium violaceum meningitis- a case report. Indian J Med Sci 1987;41:275-6.
- Ballal M, Kini P, Rajeshwari D, Shivananda PG. Chromobacterium violaceum diarrhoea. Indian J Pediatr 2000;67:388-9.
- Chattopadhyay A, Kumar V, Bhat N, Rao P. Chromobacterium violaceum infection: A rare but frequently fatal disease. J Pediatr Surg 2002;37:108- 10.
- Shenoy S, Baliga S, Wilson G, Kamath N. Chromobacterium violaceum septicemia. Indian J Pediatr 2002;69:363-4.
- Annapurna F, Reddy SVR, Kumari PL. Fatal infection by Chromobacterium violaceum: Clinical and bacteriological study. Indian J Med Sci 1979;33:8-10.
- Dutta S, Dutta SK. Multidrug resistant Chromobacterium violaceum: an unusual bacterium causing long standing wound abscess. Indian J Med Microbiol 2003;21:217-8.
- Ray P, Sharma J, Rungmei SK, Marak S, Singhi S, Taneja N, et al. Chromobacterium violaceum septicaemia from North India. Indian J Med Res 2004;120:523-26.
- Kumar MR. Chromobacterium violaceum: A rare bacterium isolated from a wound over the scalp. Int J Appl Basic Med Res 2012;2:70-2.
- Kar H, Mane V, Urhekar AD, Pachpute S, Hodiwala A, Samant S, et al. A first case report in tertiary care hospital, Navi Mumbai, India—Chromobacterium violaceum septicaemia in a child. Int J Current Microbiol App Sci 2013;2:245–249.
- Lee J, Kim JS, Nahm CH, Choi JW, Kim J, Pai SH, et al. Two cases of Chromobacterium violaceum infection after injury in a subtropical region. J Clin Microbiol 1999;37:2068-70.