What Is Elizabethkingia?

Medically Reviewed by Mahammad Juber, MD on October 13, 2022
Written by Sarah Vallie
4 min read

Antibiotic-resistant bacteria are becoming more common. Several pathogens have been discovered to be fully antibiotic-resistant and many more that are difficult to treat with antibiotics. Elizabethkingia is a type of bacteria that rarely causes severe illness, but when it does, it's difficult to treat with antibiotics.

Elizabethkingia is a genus of bacteria. It’s found worldwide in places like soil, reservoirs, and river water. In most cases, Elizabethkingia is harmless. A few strains, though, can cause illness in infants, elderly patients, and patients with compromised immune systems. For example:

Elizabethkingia anophelis.Elizabethkingia anophelis is a strain of Elizabethkingia that can be particularly dangerous to vulnerable populations. It’s unclear how Elizabethkingia anophelis spreads, and it is difficult to treat because it’s resistant to many types of antibiotics. 

Elizabethkingia anophelis has been linked to conditions such as:

  • Acute pulmonary edema, a condition in which fluid collects in the lungs.
  • Bacteremia, a condition in which bacteria gets into the bloodstream.
  • Congestive cardiac failure, a general term for instances where the heart does not work as well as it should.
  • Neonatal meningitis: swelling of the membranes that protect the brain and spinal cord of infants less than 28 days old.
  • Pneumonia, an infection that causes inflammation in the air sacs of the lungs.
  • Septicemia (sepsis): blood poisoning due to bacteria.
  • Death

Elizabethkingia meningoseptica.Elizabethkingia meningoseptica, previously named Chryseobacterium meningosepticum, often spreads in healthcare facilities and through tap water. It most often causes neonatal meningitis, but can also cause bacteremia, pneumonia, and sepsis. Elizabethkingia meningoseptica has also been known to cause a bacterial skin infection called cellulitis.

Because Elizabethkingia bacteria can contribute to so many different conditions, the symptoms of an Elizabethkingia infection can vary greatly.

Acute pulmonary edema. Acute pulmonary edema may accompany an Elizabethkingia anophelis infection. Symptoms include:

  • A cough that produces frothy spit that may have blood in it
  • Anxiety
  • Cold, clammy skin
  • Difficulty breathing, shortness of breath, and wheezing
  • Feeling like you’re suffocating or drowning
  • Rapid, irregular heartbeat

Bacteremia. Bacteremia may result from an Elizabethkingia anophelis or an Elizabethkingia meningoseptica infection. Severe cases of bacteremia can lead to:

  • Endocarditis: inflammation within the lining of the heart. Symptoms include pain, fatigue, fever and chills, night sweats, and shortness of breath.
  • Infectious arthritis: infectious inflammation of the joints. Symptoms include chills, fever, pain, and swelling.
  • Meningitis: swelling of the membranes that protect the brain and spinal cord. Symptoms include fever, headache, and a stiff neck, as well as confusion, sensitivity to light, nausea, and vomiting.
  • Osteomyelitis: inflammation or swelling in bones. Symptoms include difficulty moving or bearing weight, fever, feeling ill or in pain, redness, and warmth in the area of infection.
  • Pericarditis: swelling of the pericardium, the tissues surrounding the heart. Symptoms include chest pain, coughing, fatigue, and shortness of breath.
  • Sepsis: a severe response to an infection. Sepsis may destroy organs and tissues and lead to death. Symptoms include fever, a change in mental status, severe pain, and shortness of breath.

Cellulitis. Cellulitis has been reported in cases of Elizabethkingia meningoseptica. Symptoms of cellulitis may include:

  • Chills
  • Fever
  • Pain in the area of infection
  • Redness in the area of infection
  • Swelling in the area of infection
  • Tenderness in the area of infection
  • Warmth in the area of infection

Congestive cardiac failure. An Elizabethkingia anophelis infection may cause congestive cardiac failure. Symptoms of heart failure include:

  • Brain fog
  • Chest pain
  • Fatigue
  • An irregular or rapid heartbeat
  • Loss of appetite
  • Nausea
  • Persistent cough or wheezing
  • Rapid weight gain
  • Shortness of breath
  • Swelling in the abdomen, ankles, feet, and legs

Neonatal meningitis. Neonatal meningitis can be caused by both Elizabethkingia anophelis and Elizabethkingia meningoseptica. Meningitis that affects infants may have different symptoms than meningitis affecting adults. Symptoms to look for in infants include:

  • Abnormal reflexes
  • Slowness or inactivity
  • A bulging fontanelle (the soft spot on an infant’s head)
  • Irritability
  • Not eating or eating poorly
  • Vomiting

Pneumonia. Both Elizabethkingia anophelis and Elizabethkingia meningoseptica can cause pneumonia. Symptoms may include:

  • Changes in mental status in adults over the age of 65
  • Chest pain
  • Cough
  • Fatigue
  • Fever
  • Low body temperature
  • Nausea
  • Shortness of breath
  • Vomiting

Septicemia. Septicemia may be caused by both Elizabethkingia anophelis and Elizabethkingia meningoseptica. Symptoms of sepsis include:

  • An altered mental state
  • Coma
  • Fever
  • High heart rate
  • Light sensitivity
  • Pain
  • Nausea
  • Vomiting

Elizabethkingia outbreaks are rare, typically occurring in healthcare settings. About 5 to 10 cases are reported in the U.S. each year. 

Toward the end of 2015, though, Wisconsin had an outbreak of six cases of Elizabethkingia anophelis. This infection spread, reaching patients in Michigan and Illinois. By mid-2016, 65 people were confirmed infected, and 20 died. Many of those who became ill had underlying conditions, though, and it is unclear how much of a role the bacteria played in the 20 deaths. As of yet, health officials have not determined where the outbreak originated from.

Elizabethkingia is a gram-negative bacteria, so it is resistant to most first-line antibiotics.

A bacteria can either be Gram-negative or Gram-positive. These terms come from the Gram-staining test developed by Hans Christian Gram in 1884, which involves applying a purple stain to bacteria. Gram-positive bacteria absorb the stain, while Gram-negative bacteria don’t. 

This happens because the cell membrane of Gram-negative bacteria is more impenetrable than the membranes of Gram-positive bacteria. Gram-negative bacteria are often hard to combat due to this tough barrier.

This doesn’t mean that Elizabethkingia bacteria are undefeatable, though. Lab results show that some antibiotics do work most of the time, such as minocycline and doxycycline. However, further testing is needed.