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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
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