Clinical Overview of Elizabethkingia

Key points

  • Elizabethkingia bacteria are found worldwide, but illness is rare.
  • The disease is found mostly in healthcare or long-term care facilities.
  • Mortality from Elizabethkingia is high due to the most affected populations.
  • Elizabethkingia are resistant to some antibiotics, so clinicians should order susceptibility testing to determine the best treatment regimen.
A laboratorian holding up a plate stained with Elizabethkingia.

Overview

Elizabethkingia are gram-negative bacteria. Elizbethkingia infections are rare in the United States, with 250-500 annual cases reported. Most infections occur in small, localized outbreaks, usually in healthcare settings.

While it rarely infects healthy people, Elizabethkingia bacteria present a high risk of mortality in people who are immunocompromised. Early clinical recognition and testing are critical to ensure appropriate treatment and the best chance of patient survival.

Signs and symptoms

The infection is more common in preterm babies, people who have underlying immunosuppressing conditions, are chronically ventilated patients, or are in critical care units.

Patients often present with blood infections without an obvious source. Meningitis is common and is responsible for many of the Elizabethkingia deaths in pediatric cases. The infection can also cause:

  • Pneumonia and/or bronchitis
  • Endocarditis
  • Skin and soft tissue infection
  • Urinary tract infections
  • Bone infections
  • Catheter-associated bloodstream infections
  • Infections at surgery sites

Testing

Cases are diagnosed through culture of body fluids, most often blood testing.

CDC provides no-cost MALDI-TOF testing to confirm the bacterial species Elizabethkingia anophelis. Differentiating between E. anophelis and E. meningoseptica is essential for the best patient outcomes. The testing also can help determine if cases are part of an ongoing outbreak.

For consultation or testing questions, contact CDC's Special Bacteriology Reference Laboratory at SBRL@cdc.gov.

Resource

To learn more about Elizabethkingia and other rare pathogens, health departments, hospitals, and clinical laboratories can also access MicrobeNet. MicrobeNet is an online resource designed to assist microbiologists with identifying bacterial and fungal pathogens and is free to use.

Treatment and recovery

Elizabethkingia are naturally resistant to many commonly prescribed antibiotics.

This makes early recognition of Elizabethkingia as the infectious cause critical to ensure patients receive appropriate diagnosis and effective treatment. For best results, treatment should be selected based on antimicrobial susceptibility testing results for each suspected case. Different strains are susceptible to less commonly used antibiotics.

Resources

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About the National Center for Emerging and Zoonotic Infectious Diseases