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Chryseobacterium gleum in a man with prostatectomy in Senegal: a case report and review of the literature
© The Author(s). 2017
Received: 15 December 2016
Accepted: 15 March 2017
Published: 24 April 2017
Here we report a rare case of a urinary tract infection due to Chryseobacterium gleum. This widely distributed Gram-negative bacillus is an uncommon human pathogen and is typically associated with health care settings.
We describe a case of urinary tract infection caused by Chryseobacterium gleum in a 68-year-old man of Wolof ethnicity (an ethnic group in Senegal, West Africa) who presented to our Department of Urology in a university teaching hospital (Hôpital Aristide Le Dantec) in Dakar, Senegal, 1 month after prostatectomy. The strain isolated from a urine sample was identified as Chryseobacterium gleum by mass spectrometry (Vitek matrix-assisted laser desorption/ionization, time-of-flight, bioMérieux) and confirmed by 16S ribosomal ribonucleic acid sequencing. The organism was resistant to a wide range of antibiotics, including carbapenem, due to a resident metallo-β-lactamase gene that shared 99% of amino-acid identity with Chryseobacterium gleum class B enzym.
Infection by Chryseobacterium gleum is infrequent, and no such case has been previously reported in Africa. Despite its low virulence, Chryseobacterium gleum should be considered a potential opportunistic and emerging pathogen. Further studies on the epidemiology, pathogenicity, and resistance mechanisms of Chryseobacterium gleum are needed for better diagnosis and management.
The genus Chryseobacterium (formerly Flavobacterium) , whose type species is Chryseobacterium gleum  and belongs to the family Flavobacteriaceae (phylum Bacteroidetes), represents a group of Gram-negative, non-fermenting, catalase-positive, and indole-positive aerobic bacilli. Chryseobacterium species are uncommon human pathogens, and most cases are nosocomial and are often associated with immunosuppression or indwelling devices. Chryseobacterium is typically found in soil, water, plants, and food products and can survive in hospital environments, chlorinated water, and wet surfaces, all of which serve as potential reservoirs of infection. A literature search revealed only a few published cases in countries including Hungary, India, Croatia, and Saudi Arabia [3–6]. In Senegal, two cases of meningitis due to Flavobacterium meningosepticum were diagnosed in the late 1970s  as well as one case of Chryseobacterium indologenes . However, human C. gleum infection has not been previously reported in Africa.
Case reports of infection by Chryseobacterium gleum
Virok et al. (2014) 
Respiratory tract involvement
Garg et al. (2015) 
Dijana et al. (2015) 
Ramya et al. (2015) 
Baha et al. (2016) 
Our case (2016)
A 68-year-old man of Wolof ethnicity (an ethnic group in Senegal, West Africa) presented to our Department of Urology with severe dehydration and general deterioration of condition 1 month after prostatectomy via transurethral resection performed at a regional hospital. At hospital admittance, a clinical examination found a high blood pressure (180/90 mmHg) and a fever of 38.5 °C. Blood tests found leukocytosis with a level of 17,100/mL white blood cells (WBC), anemia with a level of 10 g/dL, and creatinine with a level of 513.3 μmol/L. Serum electrolytes showed hyponatremia with a level of 111 mEq/L, hypokalemia with a level of 3.3 mEq/L, and hypochloremia with a level of 77 mEq/L. At presentation, he had an indwelling urinary catheter draining urine incorrectly that required a urine bacteriology examination.
Treatment consisted of fluid and electrolyte replacement, daily dressing of the wound, and empiric antibiotic therapy with amikacin. This drug was chosen because of the severity of the infection and because our patient had previously received treatment with fluoroquinolone. Seven days after hospitalization, the outcome was favorable with a clean surgical wound and normalization of serum potassium and chloride levels. However, hyponatremia persisted at 119 mEq/L, and his serum creatinine level was 150.45 μmol/L. Removal of the urinary catheter was performed on day 7 of hospitalization, and he returned home the same day.
The cloudy urine collected for bacteriology examination at hospitalization was inoculated on a cysteine lactose electrolyte deficient (CLED) agar plate according to the usual techniques for medical bacteriology. Direct examination showed a rich bacterial flora, many white cells, and Gram-negative bacilli by Gram staining. The CLED agar grew yellow-colored 1 to 2 mm circular colonies (>106 CFU/mL) with regular margins.
Identification of the strain using Appareil et Procédés d’Identification 20 NE (V7.0)
Shewanella putrefaciens group
However, mass spectrometry (Vitek MS matrix-assisted laser desorption/ionization, time-of-flight, bioMérieux) successfully identified C. gleum and the result was confirmed using 16S ribosomal ribonucleic acid (rRNA) sequencing.
In this case, C. gleum was confirmed as the causative agent for our patient’s urinary tract infection as evidenced from the culture reports. Confluent growth of the organism in pure form from urine helped to rule out contamination.
In vitro antimicrobial susceptibilities of the strain, and interpretation according to Comité d’Antibiogramme de la Société Française de Microbiologie 2015 recommendations, using Pseudomonas aeruginosa ATCC 27853 and Escherichia coli ATCC 25922 as quality control
Ticarcillin + AC
C. gleum is an unusual human pathogen that has been reported as the cause of early neonatal respiratory infection in three neonates . The most common species causing human disease is F. meningosepticum followed by C. indologenes and C. gleum . Typically thought of as an organism of low virulence, C. gleum may cause serious infections, particularly among immunocompromised patients. Colonization of this organism in patients can occur via contaminated medical devices involving fluids, such as intubation tubes, respirators, humidifiers, and incubators for newborns, as previously reported . Almost, all publications available in the literature refer to long hospital stays with prolonged antibiotic treatment (>14 days), oncological disease, and most of the patients had immunosuppression or indwelling devices [8–11]. A recent case published in 2016 from Saudi Arabia, reported C. gleum pneumonia in a 6-month-old baby with nephrotic syndrome . The patient, intubated, was previously on multiple courses of antibiotics including meropenem, ceftriaxone, and vancomycin. Virok et al. reported in 2014 a case of early neonatal respiratory infection due to C. gleum in Hungary . In Croatia, Dijana et al. published in 2015 a case of C. gleum infection in a patient with malnutrition and hepatic lesion . The patient with respiratory insufficiency had developed septic shock, which necessitated intubation and mechanical ventilation. Our patient underwent a prostatectomy in a regional hospital with indwelling catheter; he had a urinary tract infection due to C. gleum, similar to an Indian case reported by Ramya et al. in 2015 .
Little is known about the virulence factor(s) of the members of Chryseobacterium, although reports have indicated that biofilm and protease production are important mechanisms involved in the virulence of Elizabethkingia meningoseptica (formerly Chryseobacterium meningosepticum) and C. indologenes . Biofilm production by C. indologenes in central venous catheter-related bloodstream infection was recently noted . E. meningoseptica isolates demonstrated 100% biofilm-forming ability in Luria-Bertani (LB) media, and increasing biofilm production is associated with the mortality rates of infected patients . Lo and Chang performed a focused study on 14 C. gleum isolates , and the strains were epidemiologically unrelated and originated primarily from urine and sputum. Their study demonstrated that 40% of C. gleum isolates could form a biofilm. The biofilm-forming potential of C. gleum appeared to be much lower than that of E. meningoseptica. Therefore, it was suggested that C. gleum might be less virulent than E. meningoseptica and C. indologenes. In fact, we previously reported a fatal case of urinary tract infection due to C. indologenes in a woman with acute leukemia . This outcome is in contrast to the present case, where the patient survived despite an advanced state of malnutrition.
Only 0.27% (50 of 18,569) of all processed non-fermenting Gram-negative bacilli (NFGNBs) and 0.03% (50 of 15,5811) of isolates collected by the SENTRY Antimicrobial Surveillance Program during the 5-year period from 1997 to 2001 were members of the genera Chryseobacterium or Elizabethkingia (formerly Chryseobacterium), with the most frequent organisms being E. meningoseptica, C. indologenes, and C. gleum . All 50 isolates were obtained from hospitalized patients, among which only two isolates (4%) were identified as C. gleum. The present case is the first reported case of a urinary tract infection in Africa by C. gleum, although C. indologenes was previously reported in Burkina Faso in 2007 , in Senegal in 2014 , and in Tunisia in 2015 . However, in Senegal, two cases of meningitis due to F. meningosepticum were diagnosed in the late 1970s .
Minimum inhibitory concentrations of β-lactams for Chryseobacterium gleum CIP 103039, in comparison with our strain
MIC (μg/mL) for:
Chryseobacterium gleum CIP 103039
Ticarcillin + AC
To the best of our knowledge, this is the first case of a C. gleum infection reported in Africa. Despite their low virulence, Chryseobacterium species should be considered a potential opportunistic pathogen that can cause infection in hospitalized patients. This report highlights the emergence of Chryseobacterium infections in Africa and emphasizes the importance of strengthening hospital hygiene measures as well as the necessity to survey environmental bacteria that could cause hospital-acquired infections.
We thank the practitioners of our Department of Urology for clinical data and the staff of the Laboratory of Bacteriology of the Aristide Le Dantec University Hospital for their technical assistance. We also thank the researchers at the Department of Medical Biotechnology, University of Siena (Italy), where work continues on this topic.
Availability of data and materials
Data sharing was not applicable to this article because no datasets were generated or analyzed during the current study.
OA, FD, MC, BF, BF, ABD, JDD, and SM conducted the case review and contributed to the writing of the case report. All authors read and approved the final report.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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