Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 7, Number 1—February 2001
Letter

An Unusual Bacterium Causing a Brain Abscess

On This Page
Article Metrics
3
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Intracranial abscesses are an important cause of illness and death in a neurologic/neurosurgical unit. Early presumptive clinical diagnosis supported by radiologic evidence (computerized axial tomography [CAT] scan and magnetic resonance imaging) is the mainstay of diagnosis (1). Abscess contents are aspirated under stereotaxic guidance and cultured to isolate causative organisms and determine their antibiotic sensitivities. Organisms isolated from brain abscesses are usually streptococci, anaerobic and facultative gram-negative bacilli, staphylococci, or pseudomonads (2).

A 24-year-old male farmer came to us with progressive headache, dizziness, and a low-grade fever of 2 weeks' duration. He had had a pimple on his right cheek approximately 3 weeks before, which had discharged "bluish" pus on forcible evacuation and subsequently healed without treatment. No focal neurologic signs were detected on physical examination. Because an intracranial space-occupying lesion was suspected, a lumbar puncture was withheld. Later, a CAT scan of the patient's head revealed a right-sided temporoparietal space-occupying lesion approximately 3 cm in diameter, suggestive of a unilocular brain abscess. The abscess was needle aspirated under stereotaxic guidance, and the pus was cultured aerobically and anaerobically. After 24 hours of aerobic incubation on MacConkey agar at 37°C, a pure growth of violet-colored colonies appeared, identified as Chromobacterium violaceum by the 20E API system (Biomerieux, France).

Other initial laboratory findings were as follows: blood leukocyte count, 16,200 cells/µL (84% neutrophlils, 15% lymphocytes, 1% eosinophils); erythrocyte sedimentation rate (Westergren method), 22 mm/hour; C-reactive protein concentration, 96 mg/L; and fasting blood sugar concentration, 5.1 mmol/L. Blood urea and C-reactive protein concentrations after 3 weeks of antibiotic treatment were 4.6 mmol/L and <6 mg/L, respectively.

The organism was sensitive to imipenem and ciprofloxacin and resistant to cefotaxime and ceftriaxone, by the Stokes comparative disk-diffusion antibiotic sensitivity testing method (3). Ciprofloxacin (as lactate) was administered intravenously, 400 mg twice daily, for 4 weeks. Repeated CAT scans, clinical symptoms, and serial C-reactive protein levels indicated rapid regression of the abscess followed by complete cure.

C. violaceum is a gram-negative bacillus present in soil and aquatic environments of tropical and subtropical countries or regions such as Trinidad, Guyana, India, Malaysia, Florida, and South Carolina. It is a bacterium of low virulence, occasionally causing skin infections and disseminated disease involving multiple organs in immunocompromised patients. In such cases the disease can mimic septicemic melioidosis (4,5).

In this previously healthy patient, infection probably originated from the facial abscess. The patient was negative for HIV antibody (Serodia), had no history of diabetes mellitus or other compromising illnesses, and had no evidence of immunodeficiency. In a previous case of disseminated C. violaceum infection in a young patient, postmortem findings revealed numerous cortical infarcts and hemorrhages (6). Our isolate from a brain abscess is yet another case of a relatively avirulent saprophytic microorganism resulting in a deep-seated infection in a well-nourished, previously healthy person.

Top

Dhammika Nanda Atapattu*, Dhammika Priyal Jayawickrama*†, and Vasanthi Thevanesam*
Author affiliations: *University of Peradeniya, Peradeniya, Sri Lanka; †General Hospital, Kandy, Sri Lanka

Top

References

  1. Mathisen  GE, Johnson  JP. Brain abscess. Clin Infect Dis. 1997;25:76381. DOIPubMed
  2. Mandell  GL. Bennett, Dolin R. Principles and practice of infectious diseases. 4th ed. New York: Churchill Livingstone; 1995. p. 887-99.
  3. Stokes  EJ, Ridgway  GL, Wren  MWD. Clinical microbiology. 7th ed. London: Edward Arnold; 1993. p. 239-50.
  4. Murray  PR, Baron  EJ, Pfaller  MA, Tenover  FC. Manual of clinical microbiology. 6th ed. Washington: ASM press; 1995: p. 503.
  5. Mitchell  RG. In: Parker MT, Duerden BI, editors. Miscellaneous bacteria. Topley and Wilson's principles of bacteriology, virology and immunity, Vol. 2. 8th ed. London: Edward Arnold; 1990. p. 589-91.
  6. Ti  TY, Tan  WC, Chong  APY. Non fatal and fatal infections caused by Chromobacterium violaceum. Clin Infect Dis. 1993;17:5057.PubMed

Top

Cite This Article

DOI: 10.3201/eid0701.700159

Related Links

Top

Table of Contents – Volume 7, Number 1—February 2001

Page created: March 17, 2011
Page updated: March 17, 2011
Page reviewed: March 17, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external