1
|
Baraka V, Andersson T, Makenga G, Francis F, Minja DTR, Overballe-Petersen S, Tang MHE, Fuursted K, Lood R. Unveiling Rare Pathogens and Antibiotic Resistance in Tanzanian Cholera Outbreak Waters. Microorganisms 2023; 11:2490. [PMID: 37894148 PMCID: PMC10609457 DOI: 10.3390/microorganisms11102490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
The emergence of antibiotic resistance is a global health concern. Therefore, understanding the mechanisms of its spread is crucial for implementing evidence-based strategies to tackle resistance in the context of the One Health approach. In developing countries where sanitation systems and access to clean and safe water are still major challenges, contamination may introduce bacteria and bacteriophages harboring antibiotic resistance genes (ARGs) into the environment. This contamination can increase the risk of exposure and community transmission of ARGs and infectious pathogens. However, there is a paucity of information on the mechanisms of bacteriophage-mediated spread of ARGs and patterns through the environment. Here, we deploy Droplet Digital PCR (ddPCR) and metagenomics approaches to analyze the abundance of ARGs and bacterial pathogens disseminated through clean and wastewater systems. We detected a relatively less-studied and rare human zoonotic pathogen, Vibrio metschnikovii, known to spread through fecal--oral contamination, similarly to V. cholerae. Several antibiotic resistance genes were identified in both bacterial and bacteriophage fractions from water sources. Using metagenomics, we detected several resistance genes related to tetracyclines and beta-lactams in all the samples. Environmental samples from outlet wastewater had a high diversity of ARGs and contained high levels of blaOXA-48. Other identified resistance profiles included tetA, tetM, and blaCTX-M9. Specifically, we demonstrated that blaCTX-M1 is enriched in the bacteriophage fraction from wastewater. In general, however, the bacterial community has a significantly higher abundance of resistance genes compared to the bacteriophage population. In conclusion, the study highlights the need to implement environmental monitoring of clean and wastewater to inform the risk of infectious disease outbreaks and the spread of antibiotic resistance in the context of One Health.
Collapse
Affiliation(s)
- Vito Baraka
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | - Tilde Andersson
- Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden;
| | - Geofrey Makenga
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | - Filbert Francis
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | - Daniel T. R. Minja
- Tanga Centre, National Institute for Medical Research, Tanga P.O. Box 5004, Tanzania; (V.B.); (G.M.); (F.F.); (D.T.R.M.)
| | | | - Man-Hung Eric Tang
- Department of Bacteria, Statens Serum Institut, Parasites and Fungi, 2300 Copenhagen, Denmark;
| | - Kurt Fuursted
- Bacterial Reference Center, Statens Serum Institut, 2300 Copenhagen, Denmark; (S.O.-P.); (K.F.)
| | - Rolf Lood
- Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden;
| |
Collapse
|
2
|
Rajni E, Goel P, Sarna MK, Jorwal A, Sharma C, Rijhwani P. The genus Ralstonia: The new kid on the block. J R Coll Physicians Edinb 2023; 53:44-52. [PMID: 36683331 DOI: 10.1177/14782715221145579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The genus Ralstonia comprises of aerobic, gram-negative, oxidase positive, nonfermentative, largely environmental organisms. They are an emerging pathogen in the hospital setting and are increasingly associated with opportunistic infections and outbreaks. We hereby present a case series of six patients diagnosed with bacteraemia caused by Ralstonia spp. and a brief review of literature. These cases highlight that isolation of a nonfermenting gram-negative bacillus from blood culture of a patient admitted in critical care setting should not be ignored as mere contaminant. Clinicians and microbiologists need to work as a team to combat this novel bug.
Collapse
Affiliation(s)
- Ekadashi Rajni
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Pallaavi Goel
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Mukesh Kumar Sarna
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Ayushi Jorwal
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Chinkle Sharma
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Puneet Rijhwani
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| |
Collapse
|
3
|
Ma J, Zhang C, Dang K, Liao Y, Feng X, Zhou P. Spherical pneumonia caused by Ralstonia mannitolilytica: a case report and literature review. BMC Pulm Med 2023; 23:20. [PMID: 36647091 PMCID: PMC9841942 DOI: 10.1186/s12890-023-02316-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Spherical pneumonia is an extremely rare condition that is difficult to diagnose. It is a specific type of lung infection that often manifests as a round or round-like mass on chest imaging. Spherical pneumonia is easily misdiagnosed as a pulmonary tumor; therefore, awareness of this disease must be strengthened. CASE PRESENTATION The patient was a 29-year-old female who had persistent cough and sputum for approximately 1 month and fever for 5 days. Chest computed tomography (CT) at our hospital revealed a mass in the lower lobe of the right lung near the hilar region, with obstructive pulmonary atelectasis and obstructive pneumonia. Although lung cancer was suspected, Ralstonia mannitolilytica was detected by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid, and no cancer cells or Mycobacterium tuberculosis were detected. Finally, the patient was diagnosed with spherical pneumonia caused by R. mannitolilytica. Anti-infective treatment, symptomatic treatment, and administration of a traditional Chinese medicine decoction were performed based on the syndrome differentiation. After 10 days of treatment, chest CT revealed few lesions in the lower lobe of the right lung, which were significantly reduced compared with those in the past. CONCLUSIONS Spherical pneumonia caused by R. mannitolilytica has not yet been reported and differential diagnosis is key in clinical diagnosis. When spherical pneumonia is difficult to diagnose, mNGS may be a better alternative.
Collapse
Affiliation(s)
- Jianli Ma
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Chuantao Zhang
- grid.415440.0Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province People’s Republic of China
| | - Kaijie Dang
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Yichao Liao
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Xue Feng
- grid.411304.30000 0001 0376 205XClinical Medical School, Chengdu University of Traditional Chinese Medicine, No 39 Shi-Er-Qiao Road, Jin Niu District, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Pengcheng Zhou
- grid.415440.0Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province People’s Republic of China
| |
Collapse
|
4
|
Liu J, Peters BM, Yang L, Yu H, Feng D, Chen D, Xu Z. Antimicrobial Treatment on a Catheter-Related Bloodstream Infection (CRBSI) Case Due to Transition of a Multi-Drug-Resistant Ralstonia mannitolilytica from Commensal to Pathogen during Hospitalization. Antibiotics (Basel) 2022; 11:antibiotics11101376. [PMID: 36290034 PMCID: PMC9599016 DOI: 10.3390/antibiotics11101376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/04/2022] [Accepted: 10/07/2022] [Indexed: 02/05/2023] Open
Abstract
Despite its commonly overlooked role as a commensal, Ralstonia mannitolilytica becomes an emerging global opportunistic human pathogen and a causative agent of various infections and diseases. In respiratory illnesses, including cystic fibrosis and chronic obstructive pulmonary disease (COPD), R. mannitolilytica is also identified presumably as colonizer. In this study, one distinctive clone of R. mannitolilytica was firstly identified as colonizer for the first 20 days during hospitalization of a patient. It was then identified as a causative agent for catheter-related bloodstream infection with negative identification after effective treatment, verifying its transition from commensal to pathogen. In conclusion, we provide convincing evidence that during hospitalization of a patient, R. mannitolilytica transitioned from commensal to pathogen in the respiratory tract leading to catheter-related bloodstream infection (CRBSI).
Collapse
Affiliation(s)
- Junyan Liu
- College of Light Industry and Food Science, Guangdong Provincial Key Laboratory of Science and Technology of Lingnan Special Food Science and Technology, Innovation Research Institute of Modern Agricultural Engineering, Zhongkai University of Agriculture and Engineering, Guangzhou 510225, China
- Key Laboratory of Green Processing and Intelligent Manufacturing of Lingnan Specialty Food, Zhongkai University of Agriculture and Engineering, Guangzhou 510225, China
| | - Brian M. Peters
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Ling Yang
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
- Centre for Translational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
- Correspondence: (L.Y.); (Z.X.); Tel.: +86-20-87113252 (Z.X.)
| | - Hui Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Donghua Feng
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Dingqiang Chen
- Department of Laboratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
- Centre for Translational Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Zhenbo Xu
- School of Food Science and Engineering, Guangdong Province Key Laboratory for Green Processing of Natural Products and Product Safety, Engineering Research Center of Starch and Vegetable Protein Processing Ministry of Education, South China University of Technology, Guangzhou 510640, China
- Department of Laboratory Medicine, The Second Affiliated Hospital of Shantou University Medical College, Shantou 515041, China
- Correspondence: (L.Y.); (Z.X.); Tel.: +86-20-87113252 (Z.X.)
| |
Collapse
|
5
|
Sun X, Cai Y, Dai W, Jiang W, Tang W. The difference of gut microbiome in different biliary diseases in infant before operation and the changes after operation. BMC Pediatr 2022; 22:502. [PMID: 36002814 PMCID: PMC9404627 DOI: 10.1186/s12887-022-03570-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/21/2022] [Indexed: 11/25/2022] Open
Abstract
Background Evidence supports an association between cholestatic liver disease and changes in microbiome composition. Nevertheless, the identification of this special type of biliary atresia from non-biliary atresia cholestasis is still a major clinical difficulty. The purpose of this study is to compare the differences in the composition of gut microbiome between infants with biliary atresia and infant with non-biliary atrestic cholestasis, to find new ways to identify and diagnose these two diseases early, to understand the influence of the presence or absence of bile on the composition of the gut microbiome in infants with cholestasis. Methods Using 16S rDNA gene sequencing technology to analyze the intestinal flora of the participants. Results In terms of diversity, there is an obvious structural separation in the intestinal microbiota of the BA group and the CD group, and this structural separation also exists in the comparison between the two groups before surgery. Taxonomic analysis demonstrated that the two groups showed an increase in Proteobacteria and Firmicutes before surgery, and the relative abundance of potential pathogens such as Shigella, Streptococcus, Klebsiella, etc. increased, potential probiotics such as Bifidobacteria and Lactobacillus decreased, but the relative abundance of each genus was different between groups. It was found that Enterococcus, Ralstonia, Nitriliruptoraceae, etc. were differentially enriched in the BA group, the CD group are mainly enriched in Veillonella, Clostridium_sensu_stricto_1 and Lactobacillus. Functional analysis of the groups showed that the BA group mainly focused on the processes of energy release processes, and the CD group mainly focused on the biosynthesis of amino-acids to consume energy. Conclusions The composition of intestinal flora is different between biliary atresia and non-biliary atretic cholestasis. Enterococcus, Ralstonia, etc. may become biomarkers for the identification and diagnosis of both.
Collapse
Affiliation(s)
- Xinhe Sun
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yaoyao Cai
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Wenwen Dai
- Department of Pediatric Surgery, Yancheng Maternity and Child Health Care Hospital, Yancheng, China
| | - Weiwei Jiang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Weibing Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
6
|
Siddiqui T, Patel SS, Sinha R, Ghoshal U, Sahu C. Ralstonia mannitolilytica: an emerging multidrug-resistant opportunistic pathogen in a tertiary care hospital setting. Access Microbiol 2022; 4:acmi000367. [PMID: 36003352 PMCID: PMC9394538 DOI: 10.1099/acmi.0.000367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction. Ralstonia mannitolilytica is a rare opportunistic pathogen capable of causing a serious infection in immunocompromised patients. Our objective was to describe all cases of R. mannitolilytica bloodstream infection identified within 2 years at our tertiary care centre, focusing on clinical characteristics, risk factors, antibiotic sensitivity patterns, management and outcomes. Case Series. We compiled a descriptive case series including 14 non-duplicate R. mannitolilytica isolates obtained from bloodstream infection samples from the microbiology laboratory of a tertiary care centre from June 2019 to June 2021. All isolates were initially identified based on their morphological properties and biochemical reactions, and then underwent matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) examination for confirmation of identity. Antibiotic susceptibility testing was performed using the Kirby–Bauer disc diffusion method and Vitek 2. All 14 patients presented with symptoms of fever and/or chills, and a positive blood culture for R. mannitolilytica. After 48 h of incubation, no Ralstonia growth was reported from any of the current environmental or pharmaceutical water samples. Chemotherapy (9/14), mechanical ventilation (4/14), steroid use (2/14) and diabetes mellitus (1/14) were associated risk factors in our patients. The antibiotic sensitivity panel showed maximum resistance to aminoglycosides (64.3%) and no resistance to cefoperazone/sulbactum. Patients received treatment with cefoperazone/sulbactum and meropenem or ceftazidime. Thirteen patients recovered with antibiotic therapy and one patient succumbed to his illness. Conclusion. R. mannitolilytica can cause bloodstream infections in immunocompromised patients. It is likely to be missed or underreported due to lack of clinical awareness. MALDI-TOF MS is helpful in rapid identification. R. mannitolilytica is resistant to many routinely used antibiotics, including carbapenems.
Collapse
Affiliation(s)
- Tasneem Siddiqui
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sangram Singh Patel
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Richa Sinha
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ujjala Ghoshal
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Chinmoy Sahu
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
7
|
Papagrigorakis E, Vavourakis M, Vlachos C, Zachariou D, Galanis A, Marougklianis V, Polyzois V, Pneumaticos S. Osteomyelitis Caused by Ralstonia mannitolilytica, a Rare Opportunistic Pathogen. Cureus 2022; 14:e24151. [PMID: 35586345 PMCID: PMC9109608 DOI: 10.7759/cureus.24151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/11/2022] Open
Abstract
Ralstonia spp. are non-fermenting aerobic gram-negative rods found in humid environments, whose role as opportunistic human pathogens has lately been recognized. Ralstonia mannitolilytica is one of the three members of the Ralstonia genus (together with Ralstonia pickettii and Ralstonia insidiosa). Bone infections by Ralstonia spp. are very rare. We report a case of femoral osteomyelitis caused by R. mannitolilytica. Among literature search, only eight cases of bone infection due to the Ralstonia genus have been described, in all of which the causative agent was identified as R. pickettii. To our knowledge, this is the first reported case of osteomyelitis attributed to R. mannitolilytica. Despite its low virulence, Ralstonia has specific characteristics that promote its spread and shows high antibiotic resistance, partly due to its ability to create a biofilm. Identification of Ralstonia spp. poses unique difficulties as the distinction between the species of the genus is not straightforward. Additionally, the bacteria may be misidentified as other closely related species. Recent data suggests that modern spectrometry and gene sequencing techniques are essential to avoid these pitfalls. Susceptibility data about the genus is limited and based on a small number of case reports, therefore there is no standardized antibiotic susceptibility testing and European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints exist. The report aims is to provide useful information on the antibiotic selection and treatment suggestions to be followed for bone infections caused by the Ralstonia genus, along with a review on the literature of this emerging opportunistic pathogen.
Collapse
|
8
|
A Rare Case of Ralstonia pickettii Infection in a Patient Undergoing Thyroid Surgery. Jundishapur J Microbiol 2021. [DOI: 10.5812/jjm.119418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: The incidence of infection by Ralstonia is increasing. Several reports describing infection by these bacteria in immunocompromised patients have been published. In this study, we reported a case of Ralstonia pickettii infection in a patient with normal immunity. Case Presentation: A woman presented with fever after thyroid surgery. We identified R. pickettii in her blood culture using 16S rRNA gene sequencing. The patient’s condition improved clinically upon treatment with levofloxacin. Conclusions: Our report highlights the potential of Ralstonia to cause sepsis in patients with normal immunity and emphasizes the importance of blood culture testing when a hospitalized patient has an unexplained high fever.
Collapse
|