Ralstonia mannitolilytica and COPD: a case report.

of the right atrium detected by magnetic resonance imaging. Transaortic fine-needle aspiration of centrally located lung cancer under endoscopic ultrasound guidance: the final frontier. Ralstonia mannitolilytica is a recently established species of clinical significance and was previously known as Pseudomonas thomasii or Ralstonia pickettii biovar 3/thomasii [1]. It has been recovered from the respiratory tract of patients with cystic fibrosis and has also been associated with catheter-associated bacteraemia, recurrent meningitis, infection of a haemoper-itoneum, urinary tract infection and post-renal transplant infection. Hospital outbreaks of R. mannitolilytica due to contamination of water [2], saline solutions [3] or oxygen-delivery devices [4] have also been reported. However, this bacterium has not been reported in patients with respiratory illnesses other than cystic fibrosis. Isolate G100 was recovered from a sputum sample from a male, 78-yr-old patient in April, 2010. This patient was presented with cough and gradually worsening dyspnoea for 1 month, but without fever. He received no antimicrobial agents prior to admission. This patient had a 20-yr history of intermittent cough, and chronic obstructive pulmonary disease (COPD) was diagnosed 10 yrs previously. He had also had type II diabetes mellitus for 5 yrs and had been a cigarette smoker for .20 yrs, but had stopped smoking 10 yrs previously. Physical examination revealed a ''barrel-shaped'' chest, reduced breath sounds and crackles. On admission, a full blood count revealed haemoglo-bin 15.1 g?dL-1 , white cell count 5.93610 9 cells?L-1 (neutrophils 4.49610 9 cells?L-1 and lymphocytes 1.25610 9 cells?L-1) and platelets 187610 9 cells?L-1. Routine serum chemistry was normal. Blood-gas analysis revealed pH 7.28, oxygen tension 64 mmHg, carbon dioxide tension 80 mmHg, HCO 3-37.6 mmol?L-1 and arterial oxygen saturation 89%, suggesting type II respiratory failure and respiratory acidosis. High-resolution chest computed tomography on admission revealed barrel-shaped chest and increased lung markings, but no infiltrations. He was diagnosed with an acute exacerbation of COPD and a sputum sample was sent on admission, from which G100 was isolated. The sputum sample was of good quality when examined by microscopy and Gram-negative rods were detected. G100 was identified as a Ralstonia sp. of Centers for Disease Control group II using a MicroScan Walkaway 96 SI automated system (Siemens Healthcare Diagnostics, Deerfield, IL, USA). Species identification was performed by partially sequencing the 16S ribosomal RNA (rRNA) gene amplified with universal primers 27F and 1492R [5]. The 1,405-bp partial 16S rRNA sequence of G100 was identical to that of R. …