title: Balanoposthitis caused by Pseudomonas aeruginosa co-producing metallo-beta-lactamase and 16S rRNA methylase in children with hematological malignancies.
abstract: Balanoposthitis is defined as the inflammation of the glans penis and its foreskin. In the presence of other underlying medical conditions, this localized infection may spread systemically, serving as a source of fever and bacteremia in neutropenic males. Two rare cases of balanoposthitis caused by a clonally related Pseudomonas aeruginosa isolate co-producing the SPM-1 metallo-beta-lactamase and the novel 16S rRNA methylase RmtD are described. Four multidrug-resistant (MDR) P. aeruginosa isolates were successively recovered from glans/foreskin swabs and urine cultures from two uncircumcised pediatric patients, one with Burkitt's non-Hodgkin's lymphoma and one with acute lymphoblastic leukemia. Clinically, preputial colonization by MDR P. aeruginosa evolved to severe balanoposthitis with glans/foreskin lesions as a source of fever. Combination therapy of ciprofloxacin and/or aztreonam (systemic) plus polymyxin B (topical) was effective once reversion of the neutropenic condition was achieved. Although P. aeruginosa remains an unusual cause of balanoposthitis, these cases should alert the physician to the potential pathogenicity of this bacterium. Furthermore, co-production of metallo-beta-lactamase and 16S rRNA methylase has a potential impact on the empirical management of complicated infections caused by P. aeruginosa.
authors: Department of Microbiology, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, Brazil. lincopan@usp.br
authors: Nilton
authors: N
authors: Lincopan
authors: Patricia
authors: P
authors: Neves
authors: Elsa M
authors: EM
authors: Mamizuka
authors: Carlos E
authors: CE
authors: Levy
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001446:Balanitis / Q000150:complications* / Q000382:microbiology; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000382:microbiology*; D008297:Male; D008780:Methyltransferases / Q000096:biosynthesis*; D010413:Penis / Q000382:microbiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000201:enzymology*; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D008780:Methyltransferases; C047346:16S rRNA (adenine(1518)-N(6)-adenine(1519)-N(6))-dimethyltransferase; C476155:beta-lactamase SPM-1, Pseudomonas aeruginosa; D001618:beta-Lactamases