Table 1 Timeline of case management
From: Unforeseeable presentation of Chryseobacterium indologenes infection in a paediatric patient
Time | Process followed | Observation and management |
|---|---|---|
Day 1 | History | Fever, pain and swelling for 3 days |
Physical examination | Swelling with erythema, warmth and tenderness | |
Blood count, erythrocyte sedimentation rate | Raised white cell count Marginally elevated erythrocyte sedimentation rate | |
X-ray | Normal tibia and fibula with subtle irregular altered soft tissue density in the lateral aspect of the mid-third of the leg | |
Blood culture | No growth after 7 days of incubation | |
Treatment | Patient was empirically given parenteral cefotaxime, metronidazole and gentamicin | |
Day 2 | Incision and drainage under general anaesthesia | Thick purulent discharge was obtained and sent for culture and sensitivity |
Gram stain | Plenty of pus cells and gram negative bacilli were seen | |
Culture | On incubation | |
Day 3 | Genus identification by conventional method | Chryseobacterium spp. Subjected for VITEK-2 identification and antibiotic sensitivity testing |
Day 4 | Species identification by conventional and VITEK-2 | C. indologenes Minimum inhibitory concentration values by VITEK-2 as in Table 2 |
Day 5 | Switching of antibiotics | Cefotaxime was changed over to ceftazidime Gentamicin was discontinued |
Day 5–12 | Local examination | Wound was healing well, secondary closure done and patient was discharged |