NC Boy Takes Deathly Ill After Dip in Local Lake

CHROMOBACTERIUM VIOLACEUM INFECTION - USA: (NORTH CAROLINA)
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Date: Fri 26 Jun 2009
Source: WWAY NewsChannel 3 (North Carolina), Associated Press (AP) report
[edited]



A 14 year old boy from North Carolina is in hospital with a rare infection
that cost him part of his nose and 5 teeth after swimming in a local lake.
The Fayetteville Observer reports that doctors at UNC [University of North
Carolina] Hospitals in Chapel Hill are treating the boy for an infection
caused by a bacterium called _Chromobacterium violaceum_, which was found
in Hope Mills Lake.

The Centers for Disease Control and Prevention says that fewer than 150
cases have been reported worldwide since 1927.

The patient's father said his son is in serious condition but that
antibiotics are beginning to clear the infection from the teen's blood.
Doctors had to remove the left side of [his] nose and palate, and his
father said he lost 5 teeth. Brian McKinney said doctors won't consider
reconstructive surgery until the infection is gone.

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[_Chromobacterium violaceum_ infection is typically found in tropical areas
and was first described by Wooley in 1905 as an infection in dead and dying
water buffalo in the Philippines (1). The 1st human case was described from
Malaysia in 1927. Most cases are reported during the summer months and are
commonly, as in this posting, associated with water exposure. The infection
may be more likely to occur in patients who are immunodeficient,
particularly those with chronic granulomatous disease. Most infections are
associated with multiple cutaneous and visceral abscesses and may be
associated with concomitant septic shock (2). This type of presentation in
a patient from a tropical environment and water exposure also suggests the
possibility of melioidosis (_Burkholderia pseudomallei_ infection).

From the description of the significant morbidity in this young man, it
appears that the organism has caused a necrotizing soft tissue infection.
Of note, a previously reported case of _C. violaceum_ linked to a (not
specified) North Carolina lake resulted in a necrotizing skin infection (3).

References
----------
1. Wooley PG. _Bacillus violaceum manilae_ (a pathogenic organism). Bull
Johns Hopkins Hosp 1905; 16: 89.
2. Jitmuang A. Human _Chromobacterium violaceum_ infection in Southeast
Asia: case reports and literature review. Southeast Asian J Trop Med Public
Health 2008; 39: 452-60 [abstract available at
].
3. Brown KL, Stein A, Morrell DS. Ecthyma gangrenosum and septic shock
syndrome secondary to _Chromobacterium violaceum_. J Am Acad Dermatol 2006;
54: S224-8 [abstract available at
]. - Mod.LL

Hope Mills Lake is a reservoir in Cumberland County in the state of North
Carolina, USA. It can be seen via the HealthMap/ProMED-mail interactive map
at . - Sr.Tech.Ed.MJ]

.................mhj/ll/mj/sh


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