Predisposition to corynebacterium jeikeium infection in acute lymphoblastic leukemia: a report of two cases in trinidad

Abstract

Two hospitalized patients (a 4 and 6 year old male and female, respectively) with acute lymphoblastic leukaemia (ALL), had each at different periods sustained burns with necrosis from extravasation of chemotherapeutic products. Pure cultures from their wound exudates and blood repeatedly revealed Corynebacterium jeikeium, an organism recognized and identified in the last decade as an opportunistic cause of life-threatening nosocomial infections particularly in patients on long-term multiple antimicrobial therapy, and in those who are neutropenic or have cardiac valve replacement. The organism has been found to be highly resistant to many antibiotics but sensitive to a few, including vancomycin. Both patients were successfully treated with vancomycin and are reviewed here to emphasize the importance of this group of microorganisms resistant to multiple antibiotic therapy as possible frequent cause of subacute bacterial infection in immunodepressed conditions such as ALL, especially when external wounds are inflicted by extravasation of antileukaemic agents (notably, vinca alkaloids). A review of the literature indicates that these are the first reported cases of infection caused by these organisms in Trinidad, and it is of clinical and therapeutic interest to note that they are sensitive to norfloxacin, polymyxin, tetracycline, and particularly vancomycin in this study.