Sepsis with an Atopobium-Like Species in a Patient with Fournier's Gangrene

Abstract

dAtopobium species are Gram-positive, anaerobic, catalase-negative, fastidious bacteria belonging to the family Coriobacteriaceae. We report the isolation of an Atopobium-like species in a patient with Fournier's gangrene and highlight the role of 16S rRNA gene sequencing in the identification of fastidious organisms in the clinical laboratory. CASE REPORTA 43-year-old mentally retarded, obese woman, without relevant medical history, was admitted to the hospital with fever and an extensive perianal abscess with spontaneous drainage during 1 week. Clinical examination showed an erythematous, swollen, warm perianal region with ulcers and regional lymphadenopathy. Hematological investigations revealed a white blood cell (WBC) count of 34.73 ϫ 10 3 cells/l (reference range of 3.90 ϫ 10 3 /l to 11.10 ϫ 10 3 /l) with 91% neutrophils (reference range of 46 to 64%), a hemoglobin level of 11.5 g/dl (reference range of 11.8 to 14.8 g/dl), and a platelet count of 418 ϫ 10 Before empirical antibiotic treatment with amoxicillin-clavulanic acid (1 g every 6 hours [q6h] intravenously [i.v.]) was initiated, two aerobic and two anaerobic blood culture bottles (Bactec FX; Becton, Dickinson, Sparks, MD) were drawn, and the patient was transferred to the operation room for incision of an ischiorectal abscess. During this procedure, a diagnosis of Fournier's gangrene (FG) was made, followed by an extended surgical debridement of all necrotic and infectious tissue. Purulent fluid was obtained and sent to the laboratory for microbiological examination. Gram staining of the pus showed predominantly Gram-positive rods and cocci. Specimens were plated onto homemade Columbia sheep blood agar and commercial chocolate agar (bioMérieux, Marnes-la-Coquette, France), both incubated in anaerobic (80% N 2 , 10% H 2 , 10% CO 2 ) and aerobic conditions at 37°C. After 48 h of incubation, catalase-negative, anaerobic, Gram-positive rods and two types of Gram-positive cocci were isolated. The cocci were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS; Microflex; Brüker, Bremen, Germany) as vancomycin-susceptible Enterococcus faecalis and Staphylococcus epidermidis. After a mean incubation time of 82.7 h at 35°C, both anaerobic blood culture bottles yielded short, rod-shaped, Gram-positive, catalase-negative bacteria. At this time, antibiotic therapy was switched to meropenem (2 g q8h i.v.). The strain was tested using the commercially available API RAPID 32A test (bioMérieux), which produced a presumptive identification of Bacillus species with poor probability (53.1%) of correct identification. MALDI-TOF MS identification of the Gram-positive rods revealed no clear match with any of the species in the database, with the best identification score being 1.304 for Bacillus cereus.Because conventional identification was inconclusive, 16S rRNA gene sequencing was performed. Bacterial DNA extraction, PCR amplification, and 16S rRNA gene sequencing were performed as described in previous studies (1) ...

Microbial characteristics across different tongue coating types in a healthy population

“…Multifunctional P. melaninogenica in saliva is also associated with oral squamous cell carcinoma [28] and is causative of periodontitis [29], Alzheimer's disease mortality [30], hyperglycemia [31], [and MHCII, CD80 and IFN-γ upregulation in salivary gland epithelial cells in Sjögren's syndrome [32]. The species A. parvulum may be associated with sepsis [33]. Moreover, the yellow tongue coating was revealed to be a tongue coating appearance that can predict esophagitis [6].…”

Transient bacteremia caused by Atopobium vaginae after caesarean delivery: Case report

“…rionic ducts by procedures and prescribed guides, without complications [7]. Th e case of sepsis caused by other Atopobium species is described in patient with fulminant Fournier's gangrene admitted to the hospital due to a perianal abscess that spontaneously drained for a week [5].…”

“…Only one case of transient bacteremia caused by Atopobium vaginae has been described in the literature so far, and only two cases of sepsis caused by other Atopobium species [5,6].…”

Necrotizing Fasciitis by Two Anaerobic Bacteria in an Immunocompetent Patient after Minor Trauma: A Case Report

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