Herbaspirillum Infection in Humans: A Case Report and Review of Literature

Table 1

Summary table of published cases of Herbaspirillum infection in humans.

Author year, country	Age/sex	Past history/predisposing conditions/cancer/HCST	Immune suppression	Likely risk factor/inciting event	Reason for admission/Clinical presentation	Initial antibiotics	Response to initial antibiotics/subsequent antibiotics	Specimen source positive for Herbaspirillum
Liu 2019, Korea	93/F	Hypertension Advanced age	N/A	—	(i) Fever, seizure; (ii) After a few days, hypoxia and chest X-ray with pneumonia	Empiric vancomycin + ceftriaxone for encephalitis	Changed to meropenem and colistin at 10 days and changed to ceftazidime, minocycline, and trimethoprim/sulfamethoxazole thereafter	Blood: Herbaspirillum huttiense; 2 months later, sputum: Herbaspirillum huttiense
Abreu-di berardino 2019, Spain	59/F	Aortic wall thrombosis, visceral and cerebral ischemic lesions, JAK2 + essential thrombocytopenia, new DM	N/A	—	(i) Generalized deconditioning; (ii) Dyspnea 10 days after admission, nosocomial pneumonia	Piperacillin-tazobactam	Recovered completely after antibiotics	Sputum: Herbaspirillum huttiense
Chen 2010, China	48/F	Acute lymphoblastic leukemia	On chemotherapy and G-CSF	Drank sugarcane juice before fever started	Fever, chills	Cefmetazole and gatifloxacin	Improved	Blood: Herbaspirillum huttiense
Spilker 2008, USA	26/m	Moderate to severe lung disease, pancreatic insufficiency, diabetes, and liver disease	Recent multiple admissions for exacerbation of respiratory symptoms	—	Fevers and rigors, MRSA, and Pseudomonas aeruginosa bacteremia	Vancomycin, piperacillin-tazobactam, and tobramyicn x 20 days Antibiotic discontinued at 20 days, after FEV1 started to improve	On the hospital day 23: fever and rigors Changed to intravenous ceftazidime and tobramycin and oral trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin, and minocycline	Blood: (GNR, initially identified as burkholderia cepacia complex) Later, identified as Herbaspirillum species
Tan 2005, USA	49/m	Probable hepatic cirrhosis	—	Homeless Jumped from a bridge into a freshwater canal in central Florida	Increasing erythema and warmth to the left leg (cellulitis)	Ampicillin/sulbactam	Antibiotics switched to cefepime and levofloxacin after initial blood culture results	Blood: (oxidase-positive nonlactose-fermenting GNR,submitted to an outside reference laboratory) positive for Herbaspirillum seropedicae
Regunath 2014, USA	46/M	Childhood asthma, atypical pneumonia as a teenager, tonsillectomy	N/A	Farming in rural Missouri, close contact with cattle and turkeys, mold and possible rat excreta; Drenched in rain during a fishing trip	Fever, fatigue, SOB, night sweats, anorexia, myalgia, and headache Dry cough, right-sided pleuritic chest pain, and worsening dyspnea Hypoxia (multilobar pneumonia)	Vancomycin, ceftriaxone, and azithromycin	Ceftriaxone switched to piperacillin-tazobactam Azithromycin switched to Doxycycline; After 12 days of treatment, the patient improved and was extubated	Blood (Day 1) (from referring facility) identified as Burkholderia cepacia complex (BCC),later as Herbaspirillum aquaticum or Herbaspirillum huttiense BAL (Day 3): GNR as Herbaspirillum aquaticum or Herbaspirillum huttiense
Chemaly 2015, USA
Hospital-based cluster of Herbaspirillium sp infections initially misidentified as B. cepacia	48/F	Ovarian adenocarcinoma	Chemotherapy	Source and mechanism of the cluster unknown	Pseudomonas BSI, sepsis-CRBSI	Cefepime (5 patients), ceftazidime (1 patient), moxifloxacin (1 patient), meropenem (1 patient) initially; Followed by ceftriaxone or fluoroquinolone	All patients improved with antibiotic and had negative repeat blood cultures; 1 patient had recurrence, which resolved once the port was removed	Blood, Infusaport tip
	67/F	Leukemia	Chemotherapy		MRSA pneumonia, sepsis-BSI			Blood
	58/M	Leukemia/HSCT	High-dose steroid		GI bleed GVHD, BSI			Blood
	55/F	Leukemia/HSCT	High-dose steroid		GI GVHD, BSI			Blood
	2/M	Ependymoma	High-dose steroid		Herbaspirillium; Sepsis-BSI			Blood
3 additional Herbaspirillium sp after continued surveillance (sporadic)	66/F	History of recurrent pneumonia, lung cancer	Radiation therapy		Herbaspirillium; Sepsis-pneumonia			Sputum
	18/M	Lymphoma	Chemotherapy		Chemotherapy; Sepsis-BSI			Blood
	51/F	Aplastic anemia/HSCT	Tacrolimus		Herbaspirillium; Sepsis- CRBSI			Blood, PICC line tip
Suwantarat 2015, USA	65/M	Multiple myeloma ESRD on hemodialysis	Steroids and lenalidomide		Acute respiratory failure and septic shock Right lower lobe pneumonia	Vancomycin, cefepime, ciprofloxacin, and micafungin	Changed to vancomycin, meropenem, and gentamicin within 12 hours However, the patient remained clinically unstable and died after 4 days	BAL (oxidase-positive, nonlactose-fermenting GNR), initially identified as Cupriavidus, later as Herbaspirillum Blood: Herbaspirillum seropedicae
Ziga 2010, USA	2/F	Acute lymphoblastic leukemia	Chemotherapy, HSCT	Uncertain Lives with her parents and grandparents on a large farm	Fever and diarrhea	Cefepime	Gentamicin added after oxidase-positive, weakly catalase-positive, Gram-negative bacillus Later, switched to meropenem	Blood Burkholderia cepacia complex As susceptibility pattern was not consistent, further identification was pursued: Herbaspirillum sp

G-CSF: granulocyte-colony stimulating factor; BAL: bronchoalveolar lavage; GI GVHD: gastrointestinal graft versus host disease; BSI: blood stream infection; CRBSI: catheter-related blood stream infection; HSCT: hematopoietic stem cell infection; GNR: gram-negative rod.