Sphingomonas paucimobilis from Blood Stream Infection to Spondylodiscitis Edmond Puca 1* , Arjan Harxhi 1 , Jonida Mehmeti 1 , Arben Rroji 2 , Gentian Huti 3 , Bekim Jata 4 , Albana Daka 5 and Dhimiter Kraja 1 1 Department of Infection Diseases, University Hospital Center, Tirana, Albania 2 Department of Radiology, University Hospital Center, Tirana, Albania 3 Service of Intensive Care Unit, Amerikan Hospital, Tirana, Albania 4 Department of Cardiology, Amerikan Hospital, Tirana, Albania 5 Department of Laboratory, Amerikan Hospital, Tirana, Albania * Corresponding author: Edmond Puca, Department of Infection Diseases, University Hospital Center, Tirana, Albania, Tel: 0672058624; E-mail: edmond_puca@yahoo.com Received date: April 20, 2015; Accepted date: May 29, 2015; Published date: June 06, 2015 Copyright: © 2015 Puca E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Sphingomonas paucimobilis, is a yellow-pigmented, aerobic, non-fermentative, gram negative motile bacillus. S. paucimobilis which is widely found in nature and hospital environments rarely cause serious or life threatening infections. It’s rarely isolated from clinical specimens but it is associated with a great variety of infections in both healthy and immunocompromised people. In this report we present two cases with infection due to S. paucimobilis. One of them was systemic blood stream infection and one focal infection. One was immunocompetent and the other with diabetes mellitus for more than ten years. Both of them were community acquired infection due S. Paucimibilis. These cases are reported to emphasize that S. paucimobilis should be kept in mind as a community acquired infection. We present the first cases of Sphingomonas paucimobilis in Albania one of which is a spondylodiscitis in immunocompetent patient and include updated literature concerning infections by this microorganism. Keywords: Sphingomonas paucimobilis; Sepsis; Spondylodiscitis; Infection Introduction Sphyngomonas paucimobilis is a gram-negative, slightly motile with polar flagellum and non-spore-forming, non-fermentative; oxidase positive and forms yellow-pigmented S colony in blood agar, opportunistic pathogen that rarely causes infections in humans [1,2]. The microorganism is widely found in natural environment, especially in water and soil [1-11]. Sphingomonas paucimobilis has been associated with variety of infections ranging from milder illness to serious ones. It has been reported to cause outbreaks of bacteremia among immunocompromised patients especially in hematology and oncology [5-8]. On the other hand it can cause infection in nonimmunocompromised patients. Among S. paucimobilis nosocomial infections, osteomyelitis is particularly rare: only 2-3 cases of osteomyelitis are recorded in the literature, both in immunosuppressed patients [10-11]. Till now the cases reported of sphingomonas has a very low mortality rate and a good prognosis unlike other gram negative bacteria. We report two cases of community acquired primary bacteremia by Sphingomonas paucimobilis. One of them is a septic shock in an immunocompromised patients and the other is a spondylodiscitis in an immunocompetent. Both of them aren’t hospital infections. Case 1 A 54-year-old female patient operated 4 years before with aortic valve stenosis, actually with mechanic valve, presented in emergence service with intermittent fever for 3 days, chills, altered mental status, and malaise. She had been suffering from diabetes mellitus for more than 10 years, medicated with oral drugs. During regular visits to the local clinic, the post-prandial finger sugar level always exceeded 200 mg/dl. On admission the patient was: febrile with fever 39.3°C, disorientated, with tachycardia, tachypnea, hypotension and oliguria. Upon admission, blood investigations were as follows: white blood cells (WBC) 21.4 × 10 6 /mm 3 (range 4-10 × 10 6 ), hemoglobin level was 12.3 g/dl, elevated of hepatic transaminases ALT was 122 UI/dl (range 0-45) and AST 165 UI/dl (range 0-35), total bilirubina was 4.74 mg/dl (normal<1.2), erythrocyte sedimentation rate (ESR) was 52 mm/h (range 12-18), fibrinogen 535 mg/dl (range 200-400), C-reactive protein (CRP) was 23.7 mg/l (range<0.5), procalcitonine (PCT) 39.8 ng/ml (range 0-2) and HbA1C 10.2%. Based on clinical and laboratory data patient was considered as sepsis with unknown pathogen for the moment. In transthorakal and transesophageal echocardiography we excluded vegetations in aortic valve and in others native valve. In total body magnetic resonance imaging (MRI) were seen ischemic lesions in left brain hemisphera, in spleen and in the right kidney. After few hours the patient complicated with acute infarction of inferior myocardial wall and right anterior ventricular wall, fatal arrhythmia, and cardiac arrest. During coronarography we have seen thrombotic lesions in proximal right coronary artery level. We had start treatment with ceftriaxone, metronidasole and moxifloksacine plus supportive therapy. Two sets of hemocultures were taken which both identified S.paucimobilis by using Vitek 2 bioMerieux system. Standardized disc diffusion of the organism by the CLSI method showed susceptibility to ceftazidime, ceftriaxone, cefoperazone, cefepime, cefotaxime, ciprofloxacin, moxifloxacin, imipenem, piperacillin-tazobactam, aztreonam, gentamicin, amikacin and trimethoprim/ sulfamethoxazole. Based on antibiogramme result we treated with intravenous imipenem 4 g/day plus levofloxacin. She responded well to the treatment and discharged on the sixteenth day. Clinical Microbiology: Open Access Puca et al., Clin Microbiol 2015, 4:3 http://dx.doi.org/10.4172/2327-5073.1000203 Case Report Open Access Clin Microbiol ISSN:2327-5073 CMO, an open access journal Volume 4 • Issue 3 • 1000203