Abstract
Burkholderia (formerly Pseudomonas) cepacia complex is a known serious threat to patients with cystic fibrosis, in whom it has the potential to cause the fatal combination of necrotizing pneumonia, worsening respiratory failure, and bacteremia, known as Cepacia syndrome. The potential for this pathogen to infect non-cystic fibrosis patients is limited and its epidemiology is poorly understood. Previously reported cases of severe Burkholderia cepacia complex lung infection in immunocompetent hosts include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions. We present a case of a 64-year-old man with Streptococcus pneumoniae community-acquired pneumonia whose hospital course was complicated by developing cavitary lung lesions, bacteremia, and acute respiratory distress syndrome. Repeated tracheal aspirate and blood cultures grew Burkholderia cepacia. Our case appears to be the first report of Cepacia syndrome in a patient without cystic fibrosis. This report raises concern regarding the potential severity of pulmonary Burkholderia cepacia complex infection and the need to broaden clinicians' suspicion for Cepacia syndrome. A framework to help diagnose and treat infected non-cystic fibrosis individuals may be useful.
Highlights
Burkholderia cepacia complex (Bcc) has been a recognized serious threat to patients with cystic fibrosis (CF) since it emerged as a major cause of severe pulmonary infection in this population in the 1980s [1,2,3]
While Burkholderia (formerly Pseudomonas) cepacia complex (Bcc) is a known threat to patients with CF, its potential to infect and harm non-CF individuals is less well established
We suspect that our patient most likely acquired the infection via respiratory equipment, as he received nebulizer therapy, noninvasive ventilation, and invasive ventilation over the course of his hospital stay
Summary
Burkholderia (formerly Pseudomonas) cepacia complex (Bcc) has been a recognized serious threat to patients with cystic fibrosis (CF) since it emerged as a major cause of severe pulmonary infection in this population in the 1980s [1,2,3]. The greatest concern of pulmonary Bcc infection is its potential to cause Cepacia syndrome, a fatal combination of necrotizing pneumonia, rapid respiratory decline, and bacteremia [3, 5, 8,9,10,11]. Cases of severe Bcc lung infection in immunocompetent hosts have been reported in the literature and include pneumonia, bronchiectasis, pyopneumothorax, and cavitary lesions [7, 14,15,16,17,18]. To the best of our knowledge, this is one very rare case of classic Cepacia syndrome in a non-CF individual and the only case of Cepacia syndrome due to nosocomial Bcc infection reported in the literature
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