Thursday, July 16, 2015

Brevundimonas Diminuta

Brevundimonas Diminuta is a Gram negative bacilli.Rarely thought to cause any disease.Hardly a dozen reports of it causing clinical infections so far. If they grow in a specimen, they call it a contaminant. But if you are so unlucky to undergo 4 heart surgeries at 5 years age, treated with 7 different parenteral antibiotics over 2 months and send home twice telling that nothing can be done, could it be the one killing you?  


Let me call her Sarah and let me tell you right in the beginning that this story doesn't have an end.

I got a call from a nearby hospital two months back, telling that one of our old operated patients is there admitted in their ICU and asking if we want to take her over to our side. Being a resident in a highly specialized unit, I was supposed to be the first one to respond. I collected her previous records and discussed with my chief. It seemed that he knew much more than what was in the documents. Just as I mentioned the name he started telling me the whole story, a complex congenital heart disease with only one ventricle, how they did a 2 stage procedure and had to abandon the second stage mid way through surgery as her heart failed to pick up, and they ended up doing a palliative surgery. I saw desperation in his eyes. He asked me to go with one consultant and to explain the parents that nothing more can be done.

We went there. A little dark girl was there, with a tube in her chest. She was probably in cardiac failure with sepsis. We explained that we had nothing more to offer and came back.

Three weeks later the parents were in my OPD. She was planning to be discharged to a palliative care center. I took the file again to my boss and to my surprise he asked me to put her in. We went on doing a full re evaluation,She had developed a pseudoaneurysm, a thinned out sac like projection from ventricle, at her previous surgery site, which was taking all the blood her heart pumps.The strange combination of problems is  unreported in medical literature.

Unconventional problems require unconventional responses. Two more surgeries were done in the next week, repairing of pseudoaneurysm and closing a leaking valve. It was as if my boss and his team was waging a war against fate, bringing out everything in his armamentarium.

She will do good some days,sit up and even tell bigger kids in nearby beds how to do chest physiotherapy to get well soon, drink kanji with pickle and paint with crayons in a colouring book gifted by her attending nurse. At times she develops breathlessness on lying down, racing our pulses high and forcing some emergency responses.

It was in one of those days, our microbiologists reported that her samples had grown Brevundimonas diminuta. They thought its a contaminant. Frankly speaking, everyone of us was hearing that name for the first time. We checked the literature. There was hardly a dozen reports of this bug causing a clinically significant infection.

But if you are unlucky enough to get such a long history in such a short time what are the odds that a are infection is insignificant? Any way she was started on antibiotics.

But the question is why do some people get such a rare fate?

I always wonder what does she think, about herself, her parents, about world as such. Does she know that there is something called death. Does she believe in fate. I dont dare to ask. I want to beleive that she knows nothing other than that she has breathlessness and we are trying to get rid of it.
But kids are hardly predictable.

Everytime I pass her, I realize how lucky I am. I have spent 3 decades on earth, I have my own troubles, but everything is minuscule compared to her fate, and that of her parents.

As I told you right in the beginning there is no end for this story.She is still sleeping in our ICU, hugging the pink teddy our anesthetist gifted her with her slender arms having an IV cannula and oximetry probe.