1. Chryseobacterium meningosepticum
Presented by:
Brittini G. Hollingsworth
June 27, 2011
CCHS MLS program

2. Objectives
At the conclusion of this presentation the audience will be able to
Recognize the different nomenclature for C. meningosepticum and identify the etiologic agent of C. meningosepticum.
Assess the symptoms and routes of transmission of C. meningosepticum.
Propose what diseases can be caused by C. meningosepticum.
Assess how C. meningosepticum is diagnosed in a clinical setting as well as the expected prognosis of the patient.
Formulate risk factors for C. meningosepticum.
Propose a treatment for C. meningosepticum including the drug of choice.
Evaluate epidemiology and prevention of C. meningosepticum including primary ages and populations affected.

3. Nomenclature & Characteristics
Flavobacterium -> Chryseobacterium -> Elizabethkingia meningoseptica.
Nonmotile, weak to nonfermentative gram negative, long, thin bacilli often with bulbous ends.
Grows well on BAP and CHOC with growth versus no growth on MacConkey
Pale yellow pigment on BAP
Mahon, Connie R., MS, Lehman, Donald C., Ed.D., MT(ASCP), SM(NRM), Manuselis, George, MA, MT(ASCP), (2011) Textbook of Diagnostic Microbiology, (4th Edition).

4. Key Biochemical Characteristics
Organism
Oxidizes mannitol
Gel
Ind
DNase
Urea
Nitrate reduction
Esculin
hydrolysis
Chryseobacterium
(Elizabethkingia)
Meningosepticum - +
Chyrseobacterium species v
Empedobacter
brevis
Forbes, Betty, Ph.D., Sahm, Daniel F., Ph.D., Weissfield, Alice S., Ph.D., (2007) Bailey &Scott’s Diagnostic Microbiology, (12th Edition). Table 26-4
Members of the family Flavobacteriaceae
Oxidase positive
Indole positive
Nonmotile

5. Etiologic agent/Causes
Member of the family Flavobacteriaceae - ubiquitous in soil and water.
An important cause of nosocomial infections mainly due to contamination of hospital equipment.
Capable of causing infection in blood, cerebrospinal fluid, skin, soft tissue, the respiratory system, and other body sites.
Typically presents as meningitis or septicemia in newborns.
In adults: pneumonia, endocarditis, bacteremia, and meningitis.

6. Route of Transmission Species Habitat (reservoir) Mode of Transmission
*C. meningosepticum,
Chryseobacterium spp.,
Empedobacter brevis,
Soil; plants; water; foodstuffs; hospital water sources, including incubators, sinks, faucets, tap water, hemodialysis systems, water baths, & other pharmaceuticals. Saline solutions. Not part of normal flora.
Exposure of patients to contaminated medical devices or solutions, but source is not always known. May colonize upper respiratory tract. * occasionally may be transmitted from birth canal to neonate.
Revised from Forbes, Betty, Ph.D., Sahm, Daniel F., Ph.D., Weissfield, Alice S., Ph.D., (2007) Bailey &Scott’s Diagnostic Microbiology, (12th Edition). St.Louis: Mosby. Table 26-1

7. Recent Studies
Ceyhan & colleagues (2008), C.meningosepticum outbreak observed in 3 clusters involving neonatal and non-neonatal pediatric patients.
Weaver & colleagues (2010), outbreak among mechanically ventilated patients in a long term acute care facility.
Cartwright & Colleagues (2010), Transmission of E. meningoseptica to tissue allograft patients.

8. Symptoms
Acute meningitis; fever, headache, nausea and vomiting, photophobia, neurological abnormalities, & altered mental status.
Infants and children; irritability, restlessness, and poor feeding.
Currently debilitated; observed clinical status changes, such as elevated body temperature, changes in respiratory status, or discoloration of respiratory secretions.

9. Diagnosis
Other than Gram stain of patient specimens, there are no specific procedures for the direct detection of these organisms in clinical material.
Serodiagnostic techniques are not generally used for the laboratory diagnosis of infections.
Validated susceptibility testing methods do not exist for organisms in this genera.

10. Treatment
Resistant to most antimicrobial agents used for treatment of gram negative rods, including aminoglycosides, beta lactam antibiotics, tetracyclines, and chloramphenicol.
Treated successfully by the combination of vancomycin and rifampin.
Other potential therapies include the quinolones and trimethoprim-sulfamethoxazole, ciprofloxacin, and clindamycin.

11. Risk factors Underlying disease, Immunosuppression, or debilitation.
The development of infection basically requires exposure of debilitated patients to a contaminated source that results in respiratory colonization.
Depending on the health of the patient, subsequent infections such as bacteremia and pneumonia may develop.

12. Prognosis Usually occurs in patients with severe underlying disease.
Mortality rate as high as 55% have been reported (neonates, epidemics in nurseries).
Sequelae of acute bacterial meningitis in children are frequent and serious.
Permanent deafness in 10% of children who recover.

13. Prevention/Epidemiology
Because this organism is ubiquitous in nature and is not generally a threat to human health, there are no recommended vaccination or prophylaxis protocols.
Hospital acquired infections are best controlled by following appropriate sterile techniques and infection control guidelines.
Also, implementing effective protocols for the sterilization and decontamination of medical supplies.

14. Preventing Nosocomial Infections
HAND WASHING
Separation of infected patients in private or cohorting rooms.
Proper PPE when caring for infected patients.
Bagging of contaminated articles.
Cleaning of all isolation rooms.

15. Questions??

16. References
Mahon, Connie R., MS, Lehman, Donald C., Ed.D., MT(ASCP), SM(NRM), Manuselis, George, MA, MT(ASCP), (2011) Textbook of Diagnostic Microbiology, (4th Edition), Saint Louis, Missouri: Saunders- Elsevier.
Forbes, Betty, Ph.D., Sahm, Daniel F., Ph.D., Weissfield, Alice S., Ph.D., (2007) Bailey &Scott’s Diagnostic Microbiology, (12th Edition). St.Louis: Mosby.
Koneman, Elmer; Winn, Jr., Washington; Allen, Stephen; Janda, William; Procop; Shcreckenberger, Paul; Woods, Gail; (2006). Koneman’s Color Atlas and Textbook of Diagnostic Microbiology, (6th Edition). Philadelphia: Lippincott Williams & Wilkins.
The Newborn Nursery and the Neonatal Intensive Care Unit. In: Jarvis, William R. (eds.), Bennett and Brachman's Hospital Infections. 5th Edition. Methuen, MA:Lippincott Williams & Wilkins; Retrieved from: database.
Kingsley N. Weaver , MPH, Roderick C. Jones , MPH, Rosemary Albright , RN, CIC, CPHQ, Yolanda Thomas , RN, Carlos H. Zambrano , MD, Michael Costello , PhD, Janet Havel , MT(ASCP), Joel Price , MS, Susan I. Gerber , MD. (2010). Acute Emergence of Elizabethkingia meningoseptica Infection among Mechanically Ventilated Patients in a Long‐Term Acute Care Facility. Infection Control and Hospital Epidemiology, 31(1),
Ceyhan M, Yildirim I, Tekeli A, Yurdakok M, Us E, Altun B, et al. (2008). A Chryseobacterium meningosepticum outbreak observed in 3 clusters involving both neonatal and non-neonatal pediatric patients. American Journal of Infection Control, 36(6),
Cartwright EJ, Prabhu RM, Zinderman CE, Schobert WE, Jensen B, Noble-Wang J, Church K, Welsh C, Keuhnert M, Burke TL, Srinivasan A, A Food and Drug Administration Tissue Safety Team Investigators. (2010). Transmission of Elizabethkingia meningoseptica (formerly Chryseobacterium meningosepticum) to tissue-allograft recipients: a report of two cases. Journal of Bone and Joint Surgery-American Volume, 92(6),