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Indian Journal of Medical Microbiology, (2014) 32(3): 323-343
1
Case Report
Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma I Biswal, *S Mohapatra, M Deb, R Dawar, R Gaind
Abstract Corynebacterium striatum is an emerging nosocomial pathogen associated with wound infections, pneumonia and meningitis. It is also a multidrug-resistant pathogen causing high morbidity. This is a report of an unusual case of wound infection in a patient with laryngeal carcinoma. Accurate diagnosis of the infection and prompt management helped in a favourable outcome for the patient. This case highlights the role of C. striatum as an important nosocomial pathogen in immunocompromised patients. Key words: Corynebacterium striatum, laryngeal carcinoma, nosocomial pathogen
Introduction Corynebacterium species are widely disseminated in the environment and comprise a part of normal skin and mucosal flora. These are Gram-positive, non-motile bacilli with clubbed ends in palisade arrangement.[1] Majority of the Corynebacterium spp. other than Corynebacterium diphtheriae were referred to as “diphtheroids” and often considered as commensal flora. However, C. striatum, C. amycolatum, C. jeikeium and C. urealyticum are some of them, which are recently recognised as pathogens.[2] C. striatum is reported as an emergent multidrug-resistant nosocomial pathogen affecting both immune-compromised and immune-competent host.[3] Here, we describe a case of C. striatum associated skin and soft tissue lesions in a patient suffering from laryngeal carcinoma. Case Report A 57-year-old male was admitted in the Department of Otorhinolaryngology at Safdarjung Hospital, Delhi in the month of April 2013, complaining mainly of difficulty in swallowing and change in voice over a period of 1 month. He was diagnosed with squamous cell carcinoma of the left piriform fossa (T2N0Mx), and underwent total laryngectomy with selective neck dissection. After surgery the patient was shifted to the ward for palliative care with a neck drain insitu. During the stay, he developed high grade fever and severe pain in the throat. Injection amikacin (500 mg twice daily for 5 days) and injection clindamycin (600 mg twice daily for 5 days) were intravenously administered. Despite *Corresponding author (email: ) Departments of Microbiology (IB, SM, MD, RG), Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, Microbiology (RD,), Indraprastha Apollo Hospital, New Delhi, India Received: 12-07-2013 Accepted: 03-12-2013
medications, the condition of the patient deteriorated. On the sixth post-operative day, a fistula was noticed at the operative site with salivary leakage. The fistula site generated copious amounts of pus. The pus samples were sent to the department of Microbiology for culture and sensitivity. Gram-stain of the sample revealed Grampositive bacilli in palisade arrangement with plenty of pus cells. The sample was inoculated on 5% Sheep blood agar and MacConkey agar medium. After overnight incubation at 37°C, a confluent growth of cream coloured nonhaemolytic colonies were observed on blood agar medium. Gram stain of the growth showed Gram-positive bacilli comparable to the ones observed in direct microscopy resembling diphtheroids. Considering diphtheroids are commensals of throat and buccal cavity, the colonies were not processed further and the report was despatched with request for a repeat specimen. However, similar growths were obtained from three successive samples sent on three consecutive days, suggestive of a probable association of the bacteria with the lesions. Albert stain from the growth showed thin bacilli with plenty of metachromatic granules. The clinician was informed accordingly regarding the isolate (suspected to be Corynebacter species) and was advised to start with intravenous vancomycin (1 g i.v. twice daily). The patient responded to the therapy and became afebrile on the third day. Simultaneously, the isolates were processed in the laboratory for phenotypic identification and antibiotic sensitivity pattern. These were catalase positive, oxidase negative, reduced nitrate to nitrite, Christensen’s urea negative, esculin hydrolysis negative, fermented only glucose and sucrose and was CAMP negative. It was finally confirmed as C. striatum using the automated system (VITEK-MS, Biomerieux, France) with anaerobic bacteria and Coryneform bacteria identification card. The strain was sensitive to trimethoprim-sulfamethoxazole, imipenem, meropenem and vancomycin, and was resistant to penicillin, tetracycline, levofloxacin, amikacin, clindamycin and erythromycin (CLSI guidelines, 2012).
[Downloaded free from http://www.ijmm.org on Saturday, July 12, 2014, IP: 220.225.230.107] || Click here to download free Android application for this journal
324
Indian Journal of Medical Microbiology
Discussion C. striatum, which is often considered as a saprophyte of skin and mucous membrane, has been recently reported as a multidrug-resistant pathogen causing long standing open wound infection. Isolation of C. striatum from a clinical specimen should not be ignored in view of its propensity to establish nosocomial infections.[3] Although, the mortality rates were observed to be low, mild skin and soft tissue infections may lead to bacteraemia, hence considered important.[4] C. striatum can establish de novo cutaneous infections through disruption of skin barriers or can invade previous cutaneous lesions,[5,6] Evidence of confluent growth isolated in pure culture on repeated cultures support its role in pathogenesis of lesion. It has been shown that the VITEK identification system is an accurate and useful method to identify Corynebacterium species.[7] Since majority of the strains are sensitive to carbapenems, linezolid and glycopeptides, the initial therapy with vancomycin could be beneficial.[8] Here, favourable outcome of the treatment occurred due to prompt introduction of intravenous vancomycin. Moreover, immediate management of C. striatum also helps in prevention of the spread of the multidrug-resistant pathogen in the hospital environment.
vol. 32, No. 3
Rev 1997;10:125-59. 2. Lee PP, Ferguson DA Jr, Sarubbi FA. Corynebacterium striatum: An underappreciated community and nosocomial pathogen. J Infect 2005;50:338-43. 3. Superti SV, Martin Dde S, Caierão J, Soares F, Prochnow T, Cantarelli VV, et al. Corynebacterium Striatum infecting a Malignant cutaneous lesion: The emergence of an opportunistic pathogen. Rev Inst Med Trop Sau Paulo 2009;51:115-6. 4. Soriano F, Rodriguez-Tudela JL, FernandezRoblas R, Aguado JM, Santamarıa M. Skin colonization by Corynebacterium groups D2 and JK in hospitalized patients. J Clin Microbiol 1998;26:1878-80. 5. Gandham NR, Singh G, Roy I, Vyawahare C, Gooptu S, Jadhav SV, et al. Necrotizing fasciitis of lower limb by Corynebacterium Striatum in a HbsAg positive patient. Int J Med Clin Res 2013;4:242-4. 6. Scholle D. A spontaneous joint infection with Corynebacterium striatum. J Clin Microbiol 2007;45:656-8. 7. Kocazeybek B, Ozder A, Kucukoglu S, Kuckates E, Yuksel H, Olga R. Report of a case with polymicrobial endocarditis related to multiresistant strains. Chemotherapy 2002;48:316-9. 8. Tarr PE, Stock F, Cooke RH, Fedorko DP, Lucey DR. Multidrug-resistant Corynebacterium striatum pneumonia in a heart transplant recipient. Transpl Infect Dis 2003;5:53-8. Access this article online
Conclusion
Quick Response Code:
C. striatum is an established nosocomial pathogen in hospital settings causing pyogenic lesions, meningitis, pneumonia, bacteraemia and endocarditis. This case report highlights the growing importance of C. striatum as a nosocomial pathogen. However, timely diagnosis and prompt treatment with intravenous vancomycin lead to favourable outcome of the patient. References 1. Funke G, von Graevenitz A, Clarridge JE 3rd, Bernard KA. Clinical microbiology of coryneform bacteria. Clin Microbiol
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.136589
How to cite this article: Biswal I, Mohapatra S, Deb M, Dawar R, Gaind R. Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma. Indian J Med Microbiol 2014;32:323-4. Source of Support: Nil, Conflict of Interest: None declared.
Legionella pneumophila infection associated with renal failure causing fatality in a known case of sarcoidosis *R Chaudhry, A Valavane, A Mohan, AB Dey
Abstract Legionella pneumophila infection may become fatal in immunocompromised state. We report here the first known fatal case from India due to Legionella pneumophila infection complicated by renal failure in a patient undergoing treatment for Sarcoidosis. Sarcoidosis is an idiopathic systemic inflammatory disease involving multiple organs. Urine antigen detection and polymerase chain reaction targeting 16S rRNA gene could help in rapid diagnosis of the infection and thereby start specific therapy. Clinical awareness along with availability of rapid diagnostic tests and institution of specific therapy may reduce morbidity and mortality associated with this infection especially in immunocompromised state. Key words: India, Legionella pneumophila, Sarcoidosis www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Indian Journal of Medical Microbiology, (2014) 32(3): 323-343
1
Case Report
Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma I Biswal, *S Mohapatra, M Deb, R Dawar, R Gaind
Abstract Corynebacterium striatum is an emerging nosocomial pathogen associated with wound infections, pneumonia and meningitis. It is also a multidrug-resistant pathogen causing high morbidity. This is a report of an unusual case of wound infection in a patient with laryngeal carcinoma. Accurate diagnosis of the infection and prompt management helped in a favourable outcome for the patient. This case highlights the role of C. striatum as an important nosocomial pathogen in immunocompromised patients. Key words: Corynebacterium striatum, laryngeal carcinoma, nosocomial pathogen
Introduction Corynebacterium species are widely disseminated in the environment and comprise a part of normal skin and mucosal flora. These are Gram-positive, non-motile bacilli with clubbed ends in palisade arrangement.[1] Majority of the Corynebacterium spp. other than Corynebacterium diphtheriae were referred to as “diphtheroids” and often considered as commensal flora. However, C. striatum, C. amycolatum, C. jeikeium and C. urealyticum are some of them, which are recently recognised as pathogens.[2] C. striatum is reported as an emergent multidrug-resistant nosocomial pathogen affecting both immune-compromised and immune-competent host.[3] Here, we describe a case of C. striatum associated skin and soft tissue lesions in a patient suffering from laryngeal carcinoma. Case Report A 57-year-old male was admitted in the Department of Otorhinolaryngology at Safdarjung Hospital, Delhi in the month of April 2013, complaining mainly of difficulty in swallowing and change in voice over a period of 1 month. He was diagnosed with squamous cell carcinoma of the left piriform fossa (T2N0Mx), and underwent total laryngectomy with selective neck dissection. After surgery the patient was shifted to the ward for palliative care with a neck drain insitu. During the stay, he developed high grade fever and severe pain in the throat. Injection amikacin (500 mg twice daily for 5 days) and injection clindamycin (600 mg twice daily for 5 days) were intravenously administered. Despite *Corresponding author (email: ) Departments of Microbiology (IB, SM, MD, RG), Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, Microbiology (RD,), Indraprastha Apollo Hospital, New Delhi, India Received: 12-07-2013 Accepted: 03-12-2013
medications, the condition of the patient deteriorated. On the sixth post-operative day, a fistula was noticed at the operative site with salivary leakage. The fistula site generated copious amounts of pus. The pus samples were sent to the department of Microbiology for culture and sensitivity. Gram-stain of the sample revealed Grampositive bacilli in palisade arrangement with plenty of pus cells. The sample was inoculated on 5% Sheep blood agar and MacConkey agar medium. After overnight incubation at 37°C, a confluent growth of cream coloured nonhaemolytic colonies were observed on blood agar medium. Gram stain of the growth showed Gram-positive bacilli comparable to the ones observed in direct microscopy resembling diphtheroids. Considering diphtheroids are commensals of throat and buccal cavity, the colonies were not processed further and the report was despatched with request for a repeat specimen. However, similar growths were obtained from three successive samples sent on three consecutive days, suggestive of a probable association of the bacteria with the lesions. Albert stain from the growth showed thin bacilli with plenty of metachromatic granules. The clinician was informed accordingly regarding the isolate (suspected to be Corynebacter species) and was advised to start with intravenous vancomycin (1 g i.v. twice daily). The patient responded to the therapy and became afebrile on the third day. Simultaneously, the isolates were processed in the laboratory for phenotypic identification and antibiotic sensitivity pattern. These were catalase positive, oxidase negative, reduced nitrate to nitrite, Christensen’s urea negative, esculin hydrolysis negative, fermented only glucose and sucrose and was CAMP negative. It was finally confirmed as C. striatum using the automated system (VITEK-MS, Biomerieux, France) with anaerobic bacteria and Coryneform bacteria identification card. The strain was sensitive to trimethoprim-sulfamethoxazole, imipenem, meropenem and vancomycin, and was resistant to penicillin, tetracycline, levofloxacin, amikacin, clindamycin and erythromycin (CLSI guidelines, 2012).
[Downloaded free from http://www.ijmm.org on Saturday, July 12, 2014, IP: 220.225.230.107] || Click here to download free Android application for this journal
324
Indian Journal of Medical Microbiology
Discussion C. striatum, which is often considered as a saprophyte of skin and mucous membrane, has been recently reported as a multidrug-resistant pathogen causing long standing open wound infection. Isolation of C. striatum from a clinical specimen should not be ignored in view of its propensity to establish nosocomial infections.[3] Although, the mortality rates were observed to be low, mild skin and soft tissue infections may lead to bacteraemia, hence considered important.[4] C. striatum can establish de novo cutaneous infections through disruption of skin barriers or can invade previous cutaneous lesions,[5,6] Evidence of confluent growth isolated in pure culture on repeated cultures support its role in pathogenesis of lesion. It has been shown that the VITEK identification system is an accurate and useful method to identify Corynebacterium species.[7] Since majority of the strains are sensitive to carbapenems, linezolid and glycopeptides, the initial therapy with vancomycin could be beneficial.[8] Here, favourable outcome of the treatment occurred due to prompt introduction of intravenous vancomycin. Moreover, immediate management of C. striatum also helps in prevention of the spread of the multidrug-resistant pathogen in the hospital environment.
vol. 32, No. 3
Rev 1997;10:125-59. 2. Lee PP, Ferguson DA Jr, Sarubbi FA. Corynebacterium striatum: An underappreciated community and nosocomial pathogen. J Infect 2005;50:338-43. 3. Superti SV, Martin Dde S, Caierão J, Soares F, Prochnow T, Cantarelli VV, et al. Corynebacterium Striatum infecting a Malignant cutaneous lesion: The emergence of an opportunistic pathogen. Rev Inst Med Trop Sau Paulo 2009;51:115-6. 4. Soriano F, Rodriguez-Tudela JL, FernandezRoblas R, Aguado JM, Santamarıa M. Skin colonization by Corynebacterium groups D2 and JK in hospitalized patients. J Clin Microbiol 1998;26:1878-80. 5. Gandham NR, Singh G, Roy I, Vyawahare C, Gooptu S, Jadhav SV, et al. Necrotizing fasciitis of lower limb by Corynebacterium Striatum in a HbsAg positive patient. Int J Med Clin Res 2013;4:242-4. 6. Scholle D. A spontaneous joint infection with Corynebacterium striatum. J Clin Microbiol 2007;45:656-8. 7. Kocazeybek B, Ozder A, Kucukoglu S, Kuckates E, Yuksel H, Olga R. Report of a case with polymicrobial endocarditis related to multiresistant strains. Chemotherapy 2002;48:316-9. 8. Tarr PE, Stock F, Cooke RH, Fedorko DP, Lucey DR. Multidrug-resistant Corynebacterium striatum pneumonia in a heart transplant recipient. Transpl Infect Dis 2003;5:53-8. Access this article online
Conclusion
Quick Response Code:
C. striatum is an established nosocomial pathogen in hospital settings causing pyogenic lesions, meningitis, pneumonia, bacteraemia and endocarditis. This case report highlights the growing importance of C. striatum as a nosocomial pathogen. However, timely diagnosis and prompt treatment with intravenous vancomycin lead to favourable outcome of the patient. References 1. Funke G, von Graevenitz A, Clarridge JE 3rd, Bernard KA. Clinical microbiology of coryneform bacteria. Clin Microbiol
Website: www.ijmm.org PMID: *** DOI: 10.4103/0255-0857.136589
How to cite this article: Biswal I, Mohapatra S, Deb M, Dawar R, Gaind R. Corynebacterium striatum: An emerging nosocomial pathogen in a case of laryngeal carcinoma. Indian J Med Microbiol 2014;32:323-4. Source of Support: Nil, Conflict of Interest: None declared.
Legionella pneumophila infection associated with renal failure causing fatality in a known case of sarcoidosis *R Chaudhry, A Valavane, A Mohan, AB Dey
Abstract Legionella pneumophila infection may become fatal in immunocompromised state. We report here the first known fatal case from India due to Legionella pneumophila infection complicated by renal failure in a patient undergoing treatment for Sarcoidosis. Sarcoidosis is an idiopathic systemic inflammatory disease involving multiple organs. Urine antigen detection and polymerase chain reaction targeting 16S rRNA gene could help in rapid diagnosis of the infection and thereby start specific therapy. Clinical awareness along with availability of rapid diagnostic tests and institution of specific therapy may reduce morbidity and mortality associated with this infection especially in immunocompromised state. Key words: India, Legionella pneumophila, Sarcoidosis www.ijmm.org
Copyright of Indian Journal of Medical Microbiology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
