Acta Clinica Belgica International Journal of Clinical and Laboratory Medicine

ISSN: 1784-3286 (Print) 2295-3337 (Online) Journal homepage: http://www.tandfonline.com/loi/yacb20

Isolation of Arcanobacterium Haemolyticum From Patients with Pharyngitis Jn Belgium M. Cambier, M. Janssens & G. Wauters To cite this article: M. Cambier, M. Janssens & G. Wauters (1992) Isolation of Arcanobacterium Haemolyticum From Patients with Pharyngitis Jn Belgium, Acta Clinica Belgica, 47:5, 303-307, DOI: 10.1080/17843286.1992.11718248 To link to this article: http://dx.doi.org/10.1080/17843286.1992.11718248

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Date: 08 August 2017, At: 02:08

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ISOLATIO N OF ARCANOBACTERIUM HAEMOLYTICUM FROM PATIENTS WITH PHARYNG ITIS JN BELGIUM .

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M.Cambier*, M.Janssens**, G.Wauters**.

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al. ric SUMMARY

During a 40 months period, 49 Arcano/Jacteriwn al. haemo/y ticum sLrains were isolated from 12,000 throat in ~wabs of patients wilh pharyngi ti s originating from 5 :an belgian provinces. All strains were recovered on sheep i2: blood olumbia agar plates, supplemented by nalidi xic . acid and colistin. In two thirds of the cases, pharyngiti s >1d was associated with a rash. Half of the cases occurred ter in the age group between I 0 and 20 years and isolates ol. were twice more frequent in females than in males. Streptococcus pyogenes was isolated 23.2 times more 'he frequently than Arcano/1acterium hae1110/ytic11m. in

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Acta Clin Belg. 47, 5: 303-7.

INTRODUCTION

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Arcanobacte ri11111 haemolyticum , form erl y Corynebacterium haemolyticum (I ) has been P~ reported as a causative agent of pharyngitis often n as ociated with rash (2-4). Although some of :s: these reports deal with large numbers of isolates repre enting up to 2 % of positive throat cu ltu res ng: from ymptomallc · patients, · the occurrence o f 19 this organism seems to be unevenly di stributed in >le various geographic areas. The reason may be rd either a difference in the epidemiology or, as ·al supposed by some authors (4, 5), a lack of awa.9. reness of thi s orga ni sm in routine laboratori es.

* Laboratoire New Larem, 5000 Namur.

** Unite de Microbiologie

UniversiteCatholiquede Louvain , UCU5490, avenue Hippocrate 54, 1200 Bruxell es. Reprints: G. Wauters

Only a few cases of A.haemolytic um infection were reported from Belgium (6) . This work dea ls with the clini ca l and bacteriological findings of 49 iso lates obtained from throat swab during a 40 month s period in Belgium. MATERIAL AND METHODS . Patients The laboratory, located in Namur, is working on ly for out pati ents. Clinical spec imens were obtained from patients li ving in li ve different belgian provin ces: Brabant , Hain aut , Li ege, Lu xembourg and amur. Posi ti ve culture were documented by asking the physician about the main clinical features, parti cul arl y phary ngiti s and rash. The study was carri ed out from January 1988 to April 1991 . Group A hae molytic streptococci were also recorded durin g a part of thi s period . Bacteriologi cal procedures

Ph aryn gea l swa bs were rece ived at the laboratory in Amies or Stuart transport medium . Th ey we re streaked onto olumbi a agar supplemented wi th 5 % sheep blood, 15 µ g/ml nalidixic acid and 10 µ g/ml coli stin . Plates were incubated at 35°C in a co2 incubator and examined for sli ghtly 13-haemolyticcoloniesafter 24 h incubation. A second reading was made after48 h. Occas ionally, colonies were observed under a stereomi croscope (magnification 10 x). Suspected ~Ionic s were subcultured and identified by conventional tests: Gram stai n, cata la e, urease, nitrate reduction, ae culin and gelati n Acta Clinica Belgica 47.5 ( 1992)

ISOLATION OF ARCANOBACTERIUM HAEMOLYTICUM FROM PATIENTS WITH PHARYNGITIS IN BELGIUM.)

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hydro lys is, fermentation of glucose, sucro e, maltose and xy lo e. Inhibition of the 13-toxin produced by Staphylococcus aureus ATCC 25923 was detected on tryptic soy agar suppl emented wi th 5 % was hed sheep ery thro cy tes. Susceptibi lity to an tibioti cs wa routinely te ted by the di c diffusion method of Kirby-Bauer. A Ml detennination of penicillin, ampic illin and erythromyci n wa also performed on 32 isolates.

R SULTS A tota l of about 12,000 throat wab were cultured from January 1988 to April 199 1. Fortynine train of A.haemolyti um were i olated (0.4

~

).

- Geographic distribution. The 49 A.haemol ticum isolates were di tributed among5 belgian provinces: 2 from Namur, 13 from Liege, 8 from Luxemb urg, 4 fr m Brabant, I from Hainaut.

- he monthly distribution of the isolates from I January 1988 to 3 1December1 990(42 train) i given in igur I . We can not explai n why no \train~ were i ~o l ated in August.

1

1

-Age and sex ratio. As can be seen in Table I, there was a marked prevalence of fem ales among l the patients. Twenty-two out of 46 patients %) were between I 0 and 19 years old. Female outnumbered males in all age groups except in ) adu lts. More than 50 % of males were in ther s group 20-29 years.

(41

- Clinical features. Data were obtained from 42 pati ents. All were suffering from phary ngitis] F as ociated with a rash in 28 of them (66 % ).

A compari son wa made between the isolation""\ rate of A.haemolyticum and Streptococcu pyogenes (group A treptococci). Figures wer M available for the period ranging from Jan uary 1990 to Apri l 199 1, involving 4,706 pharynge wabs. Twen ty-five (0.53%) strai ns 0 T A.haemolyticum were isolated versus 58 1 ( 12.J, o/o) S.pyogenes. During thi s period Ll1e rati _ S.pyogenes I A.haemolyticum wa 23.2 to one.

- Bacteriologicaljindings. All A.haemolyticunt T strain were i olated on Columbia blood agaf E supplemented with nalidi xic aci d and coli ti n After 24 h incubati on colonies were pinpoinrl sized nnd sli ghtl y fl -hae molyti c. However.

Number of isolates 7

1

......-~~~~~~~~~~~~~~~~~~~~~~~~~~~~-,

Months Fig. I : Monthly distrib111io11 of Arrn11ob11ctt!ri11111 /1111•1111d.1 ""'"" i.wflllt!.I' ( I Y/58- 1YYOJ Acta linica Belgi a 47.5 ( 1992)

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ISOLATION OF ARCANOBACTEl?/UM HA EMOLYTICUM FROM PATIENTS WITH PHARYNGITIS IN BELGIUM.

I, TABLE I : AGE AND SEX DISTRIB UTION OF ng1

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PATI ENTS IN WHOM A. HAEMOLYTICUM WAS ISOLATED.

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Age

20-29

30-39

Unknown

All ages

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1Female s

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TABLE 2: MINIMAL INHIBITORY

ONCENTRATION (µg/ml) OF PENICI LIN, AMPI ILLIN AN D

gar ERYTHROM Y IN AGA INST 32 ISOLAT · SOFA. HAEMOLYTI UM.

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~

Antibiotics

< 0.06

Penicillin

6

Ampicillin

5

Erythromycin

0.06

9

0.125

0.25

11

6

11

10

0.5

1

6

32

Acta linica Belgica 47.5 ( 1992)

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306

!SOLA TION OF ARCANOBACTERIUM HAEMOLYTICUM FROM PATIENTS WITH PHARYNGITIS IN BELGIUM.

13-haemolysis was often hardly or not at all visible at that time. After 48 h incubation, colonic , about 0.5 mm large, were dull with an opaque center when exa mined under a tereomiero cope, and surrounded by a large zo ne of a rather inco mpl ete B-hae moly si . In most in tance A.haemolytic u1n colonie were found in large numbers on the primary isolati on plates and often outnumbered the as ociated, mo. tly. treptococcal nora gr wing n the medium. ram ta in of the i. olate . how d small irregul arcoryneform gram p . itive rod , u ually di playing a granul ar staining. Biochemical characters were very constant among the 49 i olates. All were negati ve for catal a e, urea e, ge latin and ac cul in hydro ly is. Nitrate reduction wa po itive and ac id was produ cl fr m gluco e and malto e but not fr m xy lo e. ucro e yielded vari able re ult . A alient feature wa. the inhibition f the haemoly i of a 13-toxi n pr ducing Staphyloco u aureus by a perpendicu lar treak f A.haemolytic um. Antibiotic sus eptibility. The i late h wed a uniform u ceptibi lity pattern again t current antibi tic a te ted by the di c diffu ion meth d. They were usceptib le to penicillin G, cefazolin, erythromy in, tetracycline, co-trimoxazo le and clind amyc in . The Mr ' f penicil lin G, ampi cillin and erythromyc in again l 32 of our i olatc are Ii ted in Table 2.

N twith tandin g th e few report

of

A.hae111olytic um i olati n in Belgium, our tudy

ugge t that thi micro rganism may be a not uncommon cause of pharyngi ti s in ur country. The ae ti olog ic rol e of A.haem oly ticum in pharyngiti ha been que ti ned. However, Banek and Nyman i olated thi organi m I0 times more frequently fr rn pati ent with pharyngiti th an from healthy control (3). The e author al o point ut that, when pre ent n the throat of pharyngiti patient , it i i olated in large number , and thi findin g wa confirmed in our Ludy. Its Acta

linica Belgi a 47.5 ( 1992)

pathogenici ty is further evidenced by several I isolation from deep invasive sites. Our isolation ' rate of0.4% from pharyngea l swabs is rather low 1 1 in com pari son to two Scandinavian surveys i indicatin g a I% and 2% frequency, respectively, I (2,3). However, it hould be noted that in the ) ! latter study on ly tonsillitis from patients between ( I 0 to 29 years was considered. The spread of our c 49 cases over 5 belgian province and over a s three yea rs period rul es ou t any clustering ugge ting an epidemic. Our findin gs about age di tribution are in agreement with earlier report , wi th 48% of the ca e occurring between IO and 19 years and 66 % between I0 and 29 years. Thi I< is in contrast to str ptococcal pharyngiti which i much commoner in children les than IO years h old. The age distribution shown in Table I is very P simi lar to that publi hed by Banek and Nyman.' c with a li ghtly higher proportion in children d SI under 10 years in our erie (3). We noted a d signifi cant difference in the sex rati o, since the d. i olation rate wa twice a high in female than in p male . Thi was obviou in children (9 versu J) ai and teenager ( 17 ver u 5) and was reversed i fr older people, though with less ignifican t fi gu· 2 re . There wa no seasonal vari ati on in the Ir, frequency of i olation, whil e some au th or , recorded a li ght increase during the wi nter· month (2). S.

In two third of our patient , pharyngiti wa 41 as ociated with a rash, a hi gher proportion than le reported in mo l studie , u uall y accounting for rn one Lo two third of the case (2, 3, 7). N(}- de S.pyogenes wa associated with A.haemolytic ui1 in our serie , contrasting with ome reports of th i olation of another pathogen-mo stl y S.pyogene! - inone totwothird oftheca e (7). 0nl y inthre • patient wa a 13-haemolytic Streptococcu s grour isolated at the ame time. As expected, the antibiotic susceptibility of our strain did not yield unu ual results an Ml ' of erythromyc in were particularly low. Our Ludy clearly demon trates that A.haemo Jyticum occurs as an endemi c microorgani sm ir

JM !SOI.AT/ON OF ARCANOBA CTERIUM HAEMOLYTICUM FROM 'M. PATIENTS WITH PHARYNGITIS IN BELGIUM.

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ral Belgium and should be considered as a potential on cause of pharyngiti s. Thi s shou ld prompt labo)W ) ratories and physicians to take,into account thi s :ys aetiologic agent, since: (i) some cases of erupti ve !ly, pharyngiti s could otherwise be misdiagnosed as he ) scarlet fever or antibi oti c associated rash, and, en (ii) the optimal treatment for these infecti ons >Uf does not fit the usual regimens recommended for r a streptococca l pharyngiti s, erythromycin being ng here the drug of choice. ge

't ,)

nd RESUME

1is ch Quaran te-neuf so uche s d ' Arcanobact erium u s haemolyticum ont cte isolees de 12.000 frotti s . , pharynges prelcves pendant une periode de 40 mois .ry ~ chez des malades aueints de pharyngite, sejournant in. dans 5 provinces beiges. Les souches furent retrouvees en sur une gelose Columbia au sang de mouton contenant I a, de I 'acide nalidixique et de la colistine. Dans deux tiers he des cas ii s'agissait de pharyngites eruptives. L'lige de in pres de la moitie des malades se situait entre IO et 20 J) ans et deux tiers des cas etaient de sexe fCminin . La frequence d' isolement de St reptococcuspyogenes etait :u· 23,2 foi s superieure a ce ll e d' Arcanobacterium he haemolyticum.

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!f· SAMENV AITING

Tijdens een 40 maanden durend onderzoek werden a 49 Arca11obacterium haemolyticurn stammen geYsoan leerd uit 12.000 keelwissers afgenomen bij patienten ·or met faryngiti s uit 5 belgische provincies. In twee IJ' derden van de geva llen ging de faryngiti s gepaard met

307

een rash. Ongeveer de helft van de pati enten was tussen I 0 en 20 jaar oud en de prevalentie was twee maal hoger in het vrouwelijk dan in het mannelijk ges lacht. Er waren 23,2 maal meer iso laties van Streptococcus pyogenes dan van Arcanobacteriurn haemolyticum.

REFERENCES . I. Co llins MD, Jones D, Schofield GM. Reclas-

sifi cation of «Corynebacterium haemolyticum» (Mac lean, Liebow, and Rosenberg), in the genus Arcanobacterium gen.nov. as Arcanobacterium. haem.olyticum nom. rev. , comb.nov. J Gen Microbial. 1982; 128: 1279-80. 2. Se lander B, Ljun g h A. Coryneba cte rium haem.olyticum as a cause of phary ngitis (letter). J Inf ect Dis. 1986, 154: I 04 1. 3. Banek G, Nyman M. Tonsilliti s and rash associated with Corynebacterium haemolyticum. J Inf ect Dis. 1986; 154: 1037-40. 4. Mill er RA , Bran ca to F, Holm es KK . Corynebacterium haemolyticum as a cause of

pharyngiti s and scarlatiniform ras h in young adults. Ann Intern Med. 1986; I 05: 778-9. 5. Coy le MB . Co rynebacteria in Seattle. Clin Microbial News/et. 198 1; 3: 1279-80. 6. Van Bosterhaut B, Lec lercq M, Dessouroux R, Quertini er D, Wauters G. In fec tions Arcanobacterium haemolyticum (Coryneba cterium haemo/yticum): a propos de quatre observations. MM Mal Infect. 1988; 4: 2 13-5. 7. ClarTidge JE. The recogn ition and signifi cance of Arcanobacterium. haemolyticum. Clin Microbial News /et. 1969; I I: 4 1-5 .

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