Case Reports Human Chromobacterium Violaceum Infection in Southeast Asia: Case Reports and Literature Review

Chromobacterium violaceum infection in humans is a rare tropical and subtropical disease. The awareness of this organism is limited in spite its ubiquitous distribution. Several cases have been reported from Southeast Asia. A localized infection followed by an overwhelming septicemia and metastatic lesions is the usual pattern of this illness. Optimal antimicrobial treatment and duration are unknown. Consequently, the outcome is usually fatal. The study reported two patients who suffered from fulminant Chromobacterium violaceum sepsis with disseminated infection, and reviews the literature for cases reported from Southeast Asia. northern Thailand, presented with fever and right otitis externa for two days. He was previously well except for a history of perianal abscess at age 3 years. There was no history of exposure to soil or water via recreational activity or accident. An otolaryngologist prescribed him with oral cloxacillin and chloramphenicol ear drops. The infection progressed to a posterior auricular abscess with swelling of the right mastoid area, plenty of pus persistently drained from his right external auditory meatus. The same otolaryngologist performed an incision and drainage of the posterior auricular abscess after 7 days of ambulatory treatment. The patient was also admitted to Nan Hospital on 11 November 2002. On admission, he was febrile at 39oC, the respiratory rate was 22 breaths/minute, the heart rate was 100 beats/minute and his blood pressure was 110/70 mmHg. His conjunctiva were pale without icterus. Examination of the right ear showed a large amount of pus, but the site of discharge and the tympanic membrane could not be seen. Multiple pustules were identified on his face and trunk, approximately 1 mm in size. The cardiopulmonary examination was unremarkable. Abdominal disINTRODUCTION Chromobacterium violaceum is a gramnegative bacilli that can be isolated from natural aquatic habitats in tropical and subtropical regions. Chromobacterium violaceum is the exclusive species of this genus that causes human disease (Steinberg and Rio, 2005). In spite of ubiquitous distribution, human infection with this organism is rare, and awareness of the disease is limited (Chattopadhyay et al, 2002). The pattern of illness usually presents with a contaminated inoculation site, localized disease, regional lymphadenopathy, then hematogenous spread to v isceral organs (Fisher et al, 2004). The author reports two cases of Chromobacterium violaceum infection, both with fatal outcomes.