title: Community-acquired bacteremic Achromobacter xylosoxidans type IIIa pneumonia in a patient with idiopathic IgM deficiency.
abstract: A man was hospitalized with bacteremic Achromobacter xylosoxidans type IIIa pneumonia. The authors are aware of no previously reported similar infections caused by this bacterium. A clinical cure was achieved with a combination of carbenicillin and kanamycin therapy. Microtiter susceptibility testing revealed that carbenicillin was the antibiotic to which A. xylosoxidans IIIa was most sensitive (minimal inhibitory concentration, 1.6 microgram/ml) and that synergy between carbenicillin and kanamycin existed. During the patient's hospitalization, deficiency of IgM (21 mg/dl) was found. Specific serum activity against A. xylosoxidans IIIa was detected by the agglutination method. Specific anti-A. xylosoxidans IIIa IgG, but not IgM, was detected by indirect immunofluorescence. It appears that a defect in immunologic recognition of A. xylosoxidans IIIa as an invasive bacterium, a defect in synthesis of specific IgM, or both, contributed to this patient's infection.
mesh_terms: D000372:Agglutination Tests; D000421:Alcaligenes / Q000276:immunology; D000907:Antibodies, Bacterial / Q000032:analysis; D002228:Carbenicillin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004406:Dysgammaglobulinemia / Q000150:complications*; D005455:Fluorescent Antibody Technique; D006801:Humans; D007075:Immunoglobulin M; D007612:Kanamycin / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*
chemical_list: D000907:Antibodies, Bacterial; D007075:Immunoglobulin M; D007612:Kanamycin; D002228:Carbenicillin