To the Editor:
Chromobacterium violaceum is a motile gram-negative bacillus found as a saprophyte in soil and water.
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It is characterized by production of a purple pigment named violacein.2
It was first reported as a human pathogen in 1927 in Malaysia.1
Currently, it is recognized as a highly virulent opportunistic pathogen to humans, and several cases have been reported mostly from tropical and subtropical areas.1
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Usual portal of entry of C violaceum is skin. The most common presentation in patients infected with C violaceum is sepsis, which is frequently life threatening.
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The other common manifestations include cutaneous involvement, followed by abscesses in liver, lungs, spleen, lymph nodes.1
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Disseminated C violaceum infection has been reported to be associated with 60% to 80% mortality.1
C violaceum is frequently disregarded as a contaminant or misidentified. The awareness regarding this infection needs to be raised to a high degree because it is associated with high fatality rate.4
C violaceum has been commonly reported to be resistant to penicillins and cephalosporins. Therefore, in most cases of C violaceum infection, the initial empirical therapy based on penicillins and cephalosporins will not be effective and can result in increased mortality because of delay in initiation of appropriate therapy.
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However, it is usually susceptible to cotrimoxazole, fluoroquinolones, aminoglycosides, chloramphenicol, and carbapenems.1
C violaceum is able to survive under diverse environmental conditions because it produces several proteins contributing for its tolerance to antimicrobial compounds, heavy metals temperature, and acid.
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In our study, C violaceum was isolated 4 times from water samples collected under sterile precautions from operation theater taps of our hospital. Because contaminated water is the source of infection and skin is the usual portal of entry of this organism, these isolates from the hospital environment can be a source of nosocomial infection.1
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This can lead to fatal infection such as septicemia or deep abscess during pre- and postsurgical periods. Once infection is established, it should be diagnosed early, and prolonged antibiotic treatment is required.6
Regular surveillance of operation theater and critical care units for C violaceum in water samples is necessary to prevent mortality. Proper water treatment and safe water supply are also essential.References
- Fatal Chromobacterium violaceum septicaemia in northern Laos, a modified oxidase test and post-mortem forensic family G6PD analysis.Ann Clin Microbiol Antimicrob. 2009; 8: 24
- Diversity of Chromobacterium violaceum isolates from aquatic environments of state of Para, Brazilian Amazon.Mem Inst Oswaldo Cruz. 2008; 103: 678-682
- Drug resistance in Chromobacterium violaceum.Genet Mol Res. 2004; 3: 134-147
- Chromobacterium violaceum infection: a rare but frequently fatal disease.J Pediatr Surg. 2002; 37: 108-110
- Tolerance to stress and environmental adaptability of Chromobacterium violaceum.Genet Mol Res. 2004; 3: 102-116
- Chromobacterium violaceum infection: a clinical review of an important but neglected infection.J China Med Assoc. 2011; 74: 435-441
Article info
Publication history
Published online: October 18, 2012
Footnotes
Conflicts of interest: None to report.
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© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
