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      Elizabethkingia anophelis bacteremia is associated with clinically significant infections and high mortality

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          Abstract

          Unlike Elizabethkingia meningoseptica, the clinical importance of E. anophelis is poorly understood. We determined the clinical and molecular epidemiology of bacteremia caused by Elizabethkingia-like species from five regional hospitals in Hong Kong. Among 45 episodes of Elizabethkingia-like bacteremia, 21 were caused by Elizabethkingia, including 17 E. anophelis, three E. meningoseptica and one E. miricola; while 24 were caused by other diverse genera/species, as determined by 16S rRNA gene sequencing. Of the 17 cases of E. anophelis bacteremia, 15 (88%) were clinically significant. The most common diagnosis was pneumonia (n = 5), followed by catheter-related bacteremia (n = 4), neonatal meningitis (n = 3), nosocomial bacteremia (n = 2) and neutropenic fever (n = 1). E. anophelis bacteremia was commonly associated with complications and carried 23.5% mortality. In contrast, of the 24 episodes of bacteremia due to non- Elizabethkingia species, 16 (67%) were clinically insignificant. Compared to non- Elizabethkingia bacteremia, Elizabethkingia bacteremia was associated with more clinically significant infections ( P < 0.01) and positive cultures from other sites ( P < 0.01), less polymicrobial bacteremia ( P < 0.01), and higher complication ( P < 0.05) and mortality ( P < 0.05) rates. Elizabethkingia bacteremia is predominantly caused by E. anophelis instead of E. meningoseptica. Elizabethkingia bacteremia, especially due to E. anophelis, carries significant morbidity and mortality, and should be considered clinically significant unless proven otherwise.

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          Elizabethkingia anophelis sp. nov., isolated from the midgut of the mosquito Anopheles gambiae.

          The taxonomic position, growth characteristics and antibiotic resistance properties of a slightly yellow-pigmented bacterial strain, designated R26(T), isolated from the midgut of the mosquito Anopheles gambiae, were studied. The isolate produced rod-shaped cells, which stained Gram-negative. The bacterium had two growth optima at 30-31 °C and 37 °C. Strain R26(T) demonstrated natural antibiotic resistance to ampicillin, chloramphenicol, kanamycin, streptomycin and tetracycline. 16S rRNA gene sequence analysis revealed that the isolate showed 98.6 % sequence similarity to that of Elizabethkingia meningoseptica ATCC 13253(T) and 98.2 % similarity to that of Elizabethkingia miricola GTC 862(T). The major fatty acids of strain R26(T) were iso-C(15 : 0), iso-C(17 : 0) 3-OH and summed feature 4 (iso-C(15 : 0) 2-OH and/or C(16 : 1)ω7c/t). Strain R26(T) contained only menaquinone MK-6 and showed a complex polar lipid profile consisting of diphosphatidylglycerol, phosphatidylinositol, an unknown phospholipid and unknown polar lipids and glycolipids. DNA-DNA hybridization experiments with E. meningoseptica CCUG 214(T) ( = ATCC 13253(T)) and E. miricola KCTC 12492(T) ( = GTC 862(T)) gave relatedness values of 34.5 % (reciprocal 41.5 %) and 35.0 % (reciprocal 25.7 %), respectively. DNA-DNA hybridization results and some differentiating biochemical properties indicate that strain R26(T) represents a novel species, for which the name Elizabethkingia anophelis sp. nov. is proposed. The type strain is R26(T) ( = CCUG 60038(T) = CCM 7804(T)).
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            Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov.

            The taxonomic positions of six strains (including the type strain) of Chryseobacterium meningosepticum (King 1959) Vandamme et al. 1994 and the type strain of Chryseobacterium miricola Li et al. 2004 were re-evaluated by using a polyphasic taxonomic approach. Phylogenetic analysis, based on 16S rRNA gene sequencing, showed that the strains represent a separate lineage from the type strains of the Chryseobacterium-Bergeyella-Riemerella branch within the family Flavobacteriaceae (90.7-93.9 % similarities), which was supported by phenotypic differences. Combined phylogenetic and phenotypic data showed that C. meningosepticum and C. miricola should be transferred to a new genus, Elizabethkingia gen. nov., with the names Elizabethkingia meningoseptica comb. nov. (type strain, ATCC 13253(T) = NCTC 10016(T) = LMG 12279(T) = CCUG 214(T)) and Elizabethkingia miricola comb. nov. (type strain, DSM 14571(T) = JCM 11413(T) = GTC 862(T)) proposed.
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              First case of Elizabethkingia anophelis meningitis in the Central African Republic.

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                Author and article information

                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group
                2045-2322
                17 May 2016
                2016
                : 6
                : 26045
                Affiliations
                [1 ]Department of Microbiology, The University of Hong Kong , Hong Kong, China
                [2 ]State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong, China
                [3 ]Research Centre of Infection and Immunology, The University of Hong Kong , Hong Kong, China
                [4 ]Carol Yu Centre for Infection, The University of Hong Kong , Hong Kong, China
                [5 ]Department of Pathology, United Christian Hospital , Hong Kong, China
                [6 ]Department of Pathology, Pamela Youde Nethersole Eastern Hospital , Hong Kong, China
                [7 ]Department of Pathology, Kwong Wah Hospital , Hong Kong, China
                [8 ]Department of Clinical Pathology, Tuen Mun Hospital , Hong Kong, China
                Author notes
                Article
                srep26045
                10.1038/srep26045
                4868968
                27185741
                6b64c4f1-c460-4bd7-b332-5ab90cd452dd
                Copyright © 2016, Macmillan Publishers Limited

                This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

                History
                : 14 March 2016
                : 26 April 2016
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