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MEDICAL/SCIENTIFIC TOPIC

Burkholderia Cepacia Complex (BCC) in a Buenos Aires Hospital
Jorge Luis Herrera, MD

Argentina is the southernmost country of the American continent; it covers an area of 3,761,274 square kilometers and has a population of 36,223,947. Although the average population density of the country is 13-inhabitants/square km, some regions like those near Río de la Plata and Paraná rivers, Cuyo and Center regions, account for the majority of the population in contrast with semi-desert regions like Patagonia, Puna, or the far north-northeast end of the country, which have few inhabitants. The city of Buenos Aires is the capital of Argentina and accounts for 35% of the national population.

The program for Cystic Fibrosis Newborn Detection has been active since 2002 in Buenos Aires. This Screening is obligatory in all the public hospitals of the city and it is made through the Immunoreactive Trypsinogen (IRT), test that measures levels of digestive enzymes in a drop of blood taken from each newborn baby. The city has three centers specializing in care for children with CF. The three hospitals are: “Dr. Ricardo Gutiérrez” Children’s Hospital; “Dr. Juan Garraham” Paediatric Hospital; and “Dr. Pedro de Elizalde” Children’s Hospital.

“Dr. Ricardo Gutiérrez” Children’s Hospital has a multidisciplinary clinic for CF patients’ care, currently treating 136 patients. In our group of patients, the first isolation of Burkholderia cepacia was made in 1998, and, until 2001 inclusively, there was one new isolation per year. Early in 2002, there were 4 new isolations detected in patients treated in the hospital. In 2003, there was one new finding, and early in 2004 there was an outbreak of 11 new isolations in patients attending the hospital.

Urgent infection control measures were organized, and during 2005 there were no new isolations in the patients who attend regularly and who were already registered at our hospital clinic. However, since ours is a central hospital, taking patients from other regions of the country, 6 new CF patients entered our hospital system already colonized with Burkholderia cepacia. Of the 136 patients currently treated in our hospital, 25 are colonized with BCC, representing 18 % of the total. However, several of these patients have BCC in occasional sputum samples only.

The infection control measures organized during mid-2004 by the infection control specialist in our CF committee, were an adaptation of the Cystic Fibrosis Foundation’s (2001) guidelines. (“Infection Control Recommendations for patients with Cystic Fibrosis” Microbiology Important Pathogens, and infection Control Practices to Prevent Patient-to-patient transmission. Consensus Conferences, Vol X, section II, May 30-31)

It is very important to emphasize that the segregation of patients and the hospital admitting regulations have not reduced the quality of care given to our CF patients. In our hospital the layout and hygiene provisions of examination rooms, the use of masks, gloves and dickeys, allows for frequent attention to patients. Individual rooms and strict adherence to isolation measures allows the admission and care of children colonized with BCC in our hospital. There is no need to transfer them to other institutions so that the children can stay with the doctors they know. On the other hand, each new patient from another hospital is handled according to the infection control guidelines as if he or she was colonized with BCC, until the series of cultures deny or confirm its presence. With these rules we have not had new Burkholderia cepacia cases.

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A family visits the CF Clinic

From this experience we draw several important conclusions: In our country the colonization of patients with Burkholderia cepacia is a significant and increasing problem. The implementation of infection control measures can prevent dissemination of Burkholderia cepacia and other infections between patients. From 1998 to date, the BCC colonized patients of our group have not shown an accelerated decline in lung function nor have they suffered the so called “Cepacia Syndrome.”

New molecular studies will begin this year to determine the particular genomovar (the exact type of Cepacia organism) involved in our cases of Burkholderia cepacia. In the few patients studied until now, Burkholderia cenocepacia (one of the most virulent forms) has not yet been detected. This however does not diminish our alertness or the strict implementation and fulfillment of the infection control guidelines.

Facts about Argentina

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• Argentina’s independence day is July 9th (1816, from Spain).

• The official language of Argentina is Spanish. Three other unofficial, but spoken, languages are Quechua, Guarani, Araucanian.

• The population is 93 percent Roman Catholic, 2.5% Protestant, 2% Jewish, 1.5% Ukranian Catholic, 1% Armenian Orthodox.

• Argentina is the eighth largest country in the world. The total area is 1,072,157 sq mi.

• Sheep raising is one of the major industries in Patagonia, one of the regions of Argentina.

• The people of Argentina are primarily of European descent (mainly Italian and Spanish).

• Argentina has one of South America’s lowest population growth rates (1.1%) and one of its highest literacy rates (96%).

• Because of its proximity, Argentina claims part of Antarctica as its territory.

• Argentina does not observe daylight savings time.





Dr. Herrera is a graduate of the National University of Cordoba, where he received the title of physician in 1983. Immediately he was transferred to the city of Buenos Aires where began a Paediatric Residence in the Hospital of Clinics “San Martín”. After working at the Hospital of Children “Dr. Ricardo Gutiérrez,” he specialized in Paediatric Pulmonology. He currently is on staff at the Respiratory Centre in this hospital, and coordinator of the Multidisciplinary Group of Cystic Fibrosis.