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• W1987788989 abstract "Non-diphtheria Corynebacterium species have emerged as nosocomial pathogens and cause diseases in risk populations, such as the immunocompromised and patients with indwelling medical devices.1Funke G. Von Graevenitz A. Clarridge 3rd, J.E. Bernard K.A. Clinical microbiology of coryneform bacteria.Clin Microbiol Rev. 1997; 10: 125-159Crossref PubMed Google Scholar Recognized cases of bacteremia with non-diphtheria Corynebacterium spp have become more prevalent.1Funke G. Von Graevenitz A. Clarridge 3rd, J.E. Bernard K.A. Clinical microbiology of coryneform bacteria.Clin Microbiol Rev. 1997; 10: 125-159Crossref PubMed Google Scholar We report herein the first case of Corynebacterium macginleyi septicemia in an immunocompromised adult patient, which resulted in death. A 73-year old male was hospitalized with headaches, disorientation, instability, and vomiting. The patient had previously been diagnosed with non-Hodgkin lymphoma, hypertension, and type 2 diabetes mellitus. Physical examination showed partial disorientation and globally diminished osteomuscular reflexes. The patient had no motor or sensory deficits and had no signs of meningococcal irritation. Cardiopulmonary and abdominal examinations were normal. An electrocardiogram showed signs of earlier myocardial ischemia. Laboratory studies showed a hemoglobin level of 7.9 g/dl, hematocrit value of 23.6%, and normal platelet and white blood cell counts. Pancreatic and liver function tests were normal. Cerebrospinal fluid (CSF) analysis revealed 10 × 106 cells/l (mononuclear), glycorrhachia 94 mg/l (glycemia 154 mg/dl), and a total protein count of 1.1 g/l. Treponemal tests, Borrelia burgdorferi, and Brucella serology in samples from serum and CSF were also found to be negative. The results of serological tests for the human immunodeficiency virus were all negative. Herpes simplex virus IgM, cytomegalovirus IgM and IgG, and measles IgM and IgG were negative. However, herpes simplex virus IgG was positive. Computed tomography showed bilateral hypodensity and periventricular lesions. Multiple high-density signals in both cerebral hemispheres, the cerebellum, and pons were enhanced after endovascular contrasts. Urine culture was negative. On the fifth day of hospitalization, blood cultures (three out of three aerobic and anaerobic sets) were found to be positive. Small colonies were observed on the Columbia agar plate supplemented with 5% sheep blood. Colonies consisted of Gram-positive pleomorphic rods. The isolate was sub-cultured again on the same medium with and without 1% (vol/vol) of Tween 80 added at 37 °C in a 5% CO2 enriched atmosphere. Optimal growth of the strain was shown after 72 hours with Tween 80. Identification was performed with the API Coryne system (bioMérieux, France) together with API Coryne database 2.0 following the manufacturer's instructions. The results identified Corynebacterium macginleyi with a 0.87 T value. Culture of the CSF for bacteria was negative. The antimicrobial susceptibility patterns were determined by agar diffusion tests,2Deutsches Institut für Normung. Medical microbiology—methods for the determination of susceptibility of pathogens (except mycobacteria) to antimicrobial agents. DIN 58940. Deutsches Institut für Normung eV. Berlin: Beuth Verlag; 1989.Google Scholar and the minimal inhibitory concentrations (MIC) were determined by E-test (AB Biodisk, Sweden) on Mueller–Hinton blood agar supplemented with 5% sheep blood (Becton Dickinson). The isolate was sensitive to β-lactams (except penicillin G), glycopeptides, tetracycline, rifampin, and gentamicin but resistant to co-trimoxazole, quinolones, clindamycin, tobramycin, and erythromycin. A corticosteroid, ceftazidime, and clindamycin high-dose treatment was established on the fourth day of admission due to the onset of fever and leukocytosis. The patient deteriorated, showing persistent fever, a diminished level of consciousness, and septic shock. Antimicrobial susceptibility data were not available before the patient's death and therefore effective treatment could not be applied. Necropsy showed an intravascular non-Hodgkin lymphoma with central nervous system and systemic involvement. Septic shock, acute respiratory distress syndrome, and acute myocardial disease (with less than a 48-hour evolution, probably related to hemodynamic deterioration due to previous heart disease) were the final causes of death. In 1995, Riegel et al.3Riegel P. Ruimy R. de Briel D. Prevost G. Jehl F. Christen R. et al.Genomic diversity and phylogenetic relationships among lipid-requiring diphtheroids from humans and characterization of Corynebacterium macginleyi sp. nov.Int J Syst Bacteriol. 1995; 45: 128-133Crossref PubMed Scopus (69) Google Scholar were the first to establish the existence of Corynebacterium macginleyi. When this microorganism was first isolated it was defined as an exclusively conjunctival pathogen.4Giammanco G.M. Di Marco V. Priolo I. Intrivici A. Grimont F. Grimont P.A. Corynebacterium macginleyi isolation from conjunctival swab in Italy.Diagn Microbiol Infect Dis. 2002; 44: 205-207Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar However, in 2002, Villanueva et al. published the first case of infection in the urinary tract of a patient with a permanent bladder catheter.5Villanueva J.L. Domínguez A. Rios M.J. Iglesias C. Corynebacterium macginleyi isolated from urine in a patient with a permanent bladder catheter.Scand J Infect Dis. 2002; 34: 699-700Crossref PubMed Scopus (19) Google Scholar In 2003, two more cases of extraconjunctival infection with C. macginleyi were documented: one of them was an intravenous catheter-related infection6Dobler G. Braveny I. Highly resistant Corynebacterium macginleyi as cause of intravenous catheter-related infection.Eur J Clin Microbiol Infect Dis. 2003; 22: 72-73Crossref PubMed Scopus (6) Google Scholar and the other was the causal agent of infectious endocarditis.7Pubill Sucarrat M. Martinez-Costa X. Sauca Subias G. Capdevila Morell J.A. Corynebacterim macginleyi as an exceptional cause of endocarditis: a case report.An Med Interna. 2003; 20: 654-655PubMed Google Scholar The number of isolates from conjunctiva swabs (n = 28, 90%) suggests that the ocular region is the main habitat for this microorganism, although there has been no systematic examination of this bacterium in any parts of the body other than the throat and conjunctiva.8Von Graevenitz A. Pünter-Streit V. Riegel P. Funke G. Coryneform bacteria in throat cultures of healthy individuals.J Clin Microbiol. 1998; 36: 2087-2088PubMed Google Scholar, 9Von Graevenitz A. Schumacher U. Bernauer W. The corynebacterial flora of the normal human conjunctiva is lipophilic.Curr Microbiol. 2001; 42: 372-374Crossref PubMed Scopus (8) Google Scholar A variety of antibiotic regimens have been used successfully in the management of extraconjunctival cases (glycopeptides,5Villanueva J.L. Domínguez A. Rios M.J. Iglesias C. Corynebacterium macginleyi isolated from urine in a patient with a permanent bladder catheter.Scand J Infect Dis. 2002; 34: 699-700Crossref PubMed Scopus (19) Google Scholar beta-lactams,6Dobler G. Braveny I. Highly resistant Corynebacterium macginleyi as cause of intravenous catheter-related infection.Eur J Clin Microbiol Infect Dis. 2003; 22: 72-73Crossref PubMed Scopus (6) Google Scholar beta-lactams with aminoglycosides,7Pubill Sucarrat M. Martinez-Costa X. Sauca Subias G. Capdevila Morell J.A. Corynebacterim macginleyi as an exceptional cause of endocarditis: a case report.An Med Interna. 2003; 20: 654-655PubMed Google Scholar and beta-lactams with clindamycin in the present report). The susceptibility of the analyzed strains appears to be different. The strain isolated in the catheter-related infection6Dobler G. Braveny I. Highly resistant Corynebacterium macginleyi as cause of intravenous catheter-related infection.Eur J Clin Microbiol Infect Dis. 2003; 22: 72-73Crossref PubMed Scopus (6) Google Scholar was resistant to a greater number of antimicrobials (beta-lactams, beta-lactams with inhibitors, quinolones, monobactams, gentamicin, macrolides, co-trimoxazole, and lincosamides) and it was only sensitive to vancomycin, netilmicin, and tetracycline. The other three reported strains (one from a urinary tract infection,5Villanueva J.L. Domínguez A. Rios M.J. Iglesias C. Corynebacterium macginleyi isolated from urine in a patient with a permanent bladder catheter.Scand J Infect Dis. 2002; 34: 699-700Crossref PubMed Scopus (19) Google Scholar one the agent of infectious endocarditis,7Pubill Sucarrat M. Martinez-Costa X. Sauca Subias G. Capdevila Morell J.A. Corynebacterim macginleyi as an exceptional cause of endocarditis: a case report.An Med Interna. 2003; 20: 654-655PubMed Google Scholar and the one found in the present report) were sensitive to beta-lactams (except for penicillin, in this case report), rifampin, and glycopeptides and they were resistant to quinolones, lincosamides, and co-trimoxazole. With respect to the aminoglycosides, two out of the three cases were resistant to tobramycin and susceptible to gentamicin, while only one case was susceptible to erythromycin.5Villanueva J.L. Domínguez A. Rios M.J. Iglesias C. Corynebacterium macginleyi isolated from urine in a patient with a permanent bladder catheter.Scand J Infect Dis. 2002; 34: 699-700Crossref PubMed Scopus (19) Google Scholar The susceptibility patterns of strains isolated in eye swabs bear a greater resemblance to each other. In a study by Joussen et al.,10Joussen A.M. Funke G. Joussen F. Herbertz G. Corynebacterium macginleyi: a conjunctiva specific pathogen.Br J Ophthalmol. 2000; 84: 1420-1422Crossref PubMed Scopus (43) Google Scholar 66% of the strains were sensitive to chloramphenicol. Giammanco et al.4Giammanco G.M. Di Marco V. Priolo I. Intrivici A. Grimont F. Grimont P.A. Corynebacterium macginleyi isolation from conjunctival swab in Italy.Diagn Microbiol Infect Dis. 2002; 44: 205-207Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar described an isolate that was susceptible to a group of antimicrobials: beta-lactams with and without inhibitors, macrolides, aminoglycosides, glycopeptides, quinolones, lincosamides, rifampin, tetracycline, and chloramphenicol. Even though the patient described in our case most probably died of intravascular non-Hodgkin lymphoma and acute myocardial diseases, the potential virulence of C. macginleyi must be considered when it is isolated in pure culture. Cases of ocular infections related to Corynebacterium spp are probably underreported in the literature. This may be due to underestimation of the possible association between ocular infections and coryneform bacteria. Isolations in pure culture samples, its discovery in patients with indwelling catheters, its presence in sterile tissues and/or urine, and certain clinical signs in immunocompromised patients, should not be underestimated. The increasing number of reported infections with C. macginleyi and the continued growth in the number of immunocompromised patients suggests that infection with this pathogen is likely to become more widespread. More information is needed on the factors that predispose patients to systemic infection and on the primary site of infection, as well as other pathogenic properties of C. macginleyi. Despite the limited number of isolates reported and the incomplete available data, the literature suggests that vancomycin should be the preferred treatment for non-ocular C. macginleyi infections. If glycopeptides cannot be used, the results of susceptibility testing should be used to determine another treatment option. This case was presented in part at the 12th International Congress on Infectious Diseases, Lisbon, Portugal, June 15–18, 2006. Conflict of interest: No conflict of interest to declare." @default.
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• W1987788989 title "Septicemia caused by Corynebacterium macginleyi: a rare form of extraocular infection" @default.
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