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Xanthomonas maltophilia: an emerging pathogen in patients with HIV disease
R Manfredi1, A Nanetti, M Ferri
1Department of Clinical and Experimental Medicine, University of Bologna, Italy.
Abstract:
Fifty-four episodes of Xanthomonas maltophilia infection were observed in 52 HIV-infected patients out of 2062 assessed (2.52%) over a 6-year period: sepsis/bacteraemia in 44 cases, lower airways infection in 5 cases, urinary tract infection and pharyngitis in 2 cases each, and lymph node involvement in one patient. X. maltophilia represented the fourth most common non-mycobacterial bacterial pathogen responsible for bacteraemia in HIV-infected patients: 44 cases out of 721 diagnosed (6.1%). When compared with non-typhoid Salmonella spp. bacteraemia, an increased risk to develop X. maltophilia disseminated infection was seen according to the progression of HIV-related immunodeficiency, the occurrence of leukopenia-neutropenia, central venous catheterization, previous antibiotic and/or corticosteroid treatment, and hospitalization. In 3 patients suffering from concurrent AIDS-related disorders, X. maltophilia infection contributed to death, while a recurrence occurred in 2 cases only. Due to the poor antimicrobial susceptibility of this pathogen (also confirmed in our series), X. maltophilia bacteraemia associated with advanced HIV infection and concurrent risk factors, may represent a potentially severe disease.
Insights
Xanthomonas maltophilia infections are a significant concern in HIV-infected patients, particularly those with advanced immunodeficiency. Early identification and management are crucial due to the pathogen
Area of Science:
- Infectious Diseases
- HIV/AIDS Research
- Clinical Microbiology
Background:
- Human immunodeficiency virus (HIV) infection compromises the immune system, increasing susceptibility to opportunistic infections.
- Xanthomonas maltophilia (X. maltophilia) is an opportunistic pathogen with increasing clinical relevance.
- Understanding the epidemiology and risk factors of X. maltophilia infections in HIV patients is crucial for patient management.
Purpose of the Study:
- To investigate the incidence, clinical manifestations, and risk factors of X. maltophilia infections in a cohort of HIV-infected patients.
- To compare the risk of X. maltophilia disseminated infection with other bacterial pathogens in HIV-infected patients.
- To assess the clinical outcomes and mortality associated with X. maltophilia infections in this population.
Main Methods:
- Retrospective analysis of medical records of HIV-infected patients over a 6-year period.
- Identification and characterization of X. maltophilia isolates from various infection sites.
- Statistical comparison of risk factors between X. maltophilia bacteraemia and non-typhoid Salmonella spp. bacteraemia.
Main Results:
- Fifty-four episodes of X. maltophilia infection were identified in 52 out of 2062 HIV-infected patients (2.52%).
- Sepsis/bacteraemia was the most common manifestation (44 cases), with X. maltophilia being the fourth most common non-mycobacterial bacterial cause of bacteraemia.
- Advanced HIV immunodeficiency, leukopenia-neutropenia, central venous catheterization, prior antibiotic/corticosteroid use, and hospitalization were associated with an increased risk of disseminated X. maltophilia infection.
Conclusions:
- X. maltophilia represents a significant opportunistic pathogen in HIV-infected individuals, particularly those with advanced disease and specific risk factors.
- The pathogen's poor antimicrobial susceptibility contributes to the potential severity of X. maltophilia bacteraemia in this vulnerable population.
- Clinical vigilance and appropriate management strategies are essential for improving outcomes in HIV patients with X. maltophilia infections.