Bacteremia Caused by Gordonia bronchialis in a Patient with Sequestrated Lung

Abstract

Gordonia species have been recognized as pathogens in immunocompromised and immunocompetent patients. We report the first case of bacteremia due to Gordonia bronchialis in a diabetic patient with a sequestrated lung. Species identification was confirmed with mycolic acid analysis by high-performance liquid chromatography and sequencing of the 16S rRNA gene.A 58-year-old woman with recently discovered diabetes mellitus, long-standing spondylolisthesis, and asthma presented with acute exacerbation of low back pain after an exercise session. Breathlessness, fever, and chills accompanied the pain. The patient had been treated for a pleural effusion and a loculated lung cyst with drainage 15 and 5 years previously, respectively. On physical examination, the patient was febrile with a reduced ability to raise and straighten her right leg and diminished deep tendon reflexes of the right lower limb. The patient's white cell count was elevated, at 15 ϫ 10 9 /liter, with a predominance of polymorphs (86%). Chest X-rays showed pneumonic-type lung consolidation, and consequently the patient was treated with ceftriaxone and clarithromycin for community-acquired pneumonia. Computer-assisted tomography of the thorax suggested a sequestrated lung.Subsequent magnetic resonance imaging of the lumbosacral spine showed a 5-mm air pocket with enhancement surrounding the lesion from L4 to S1. The antimicrobials with which the patient was treated were changed to cloxacillin for osteomyelitis and ceftazidime for possible infection with Burkholderia pseudomallei, which is endemic in the southeast Asia region. On the fifth day, blood cultures taken during admission and incubated in Bactec 9000 (Becton Dickinson, Cockeysville, Md.) were positive for growth. Haemophilus aphrophilus was isolated upon subculture on a blood agar plate and identified by using XV disks and the API NH (bioMérieux, Marcyl'Etoile, France) system. The isolate was found to be susceptible to ceftriaxone by the disk diffusion method. A transthoracic echocardiogram was normal. However, the patient's health did not improve and her neurological status deteriorated, with a loss of ankle reflex. A repeat scan of the lumbar spine demonstrated a subcortical mass at L3 to L4 with a left paravertebral abscess extending inferiorly to the gluteal region. Reincubation of the original blood agar plate for an additional 5 days revealed the presence of a second organism, which formed translucent, nonhemolytic, dry, wrinkled colonies within 24 h; these colonies became opaque, rough, and salmon colored at 72 h. Growth and pigmentation were demonstrated at 35°C with ambient air on Trypticase soy agar with sheep blood, chocolate agar, and brain heart infusion agar. The isolate was a beaded gram-positive bacillus which was weakly acid-fast. The microscopic appearance of the growth on a water agar plate showed symmetra and no aerial hyphae. Tests for lysozyme, casein, tyrosine, and xanthine hydrolysis were negative, while tests for urease and nitrate were positive after 48 h and a test fo...

Native Valve Endocarditis Due to Gordonia polyisoprenivorans : Case Report and Review of Literature of Bloodstream Infections Caused by Gordonia Species

“…In our case, the isolate was initially misidentified as a Corynebacterium pseudodiphtheriticum by a rapid commercial identification system (RapID CB Plus). Other case reports have also described difficulties in identifying members of this genus (4,20,22). Two case reports that described infections caused by G. bronchialis also reported the misidentification of G. bronchialis as Rhodococcus spp.…”

“…One case of G. sputi bacteremia in a young man with metastatic melanoma who was receiving intravenous interleukin-2 was previously reported (19). Lastly, a case of bacteremia due to Gordonia bronchialis in a diabetic patient with a sequestrated lung was previously reported (20).…”

“…Two case reports that described infections caused by G. bronchialis also reported the misidentification of G. bronchialis as Rhodococcus spp. when another commercial identification system was used, API Coryne (bioMérieux, Hazelwood, MO), with an API code of 1111104 (20,22). Identification to the genus level required the use of HPLC analysis, and identification to the species level required genetic methods such as 16S rRNA gene sequencing.…”

Breast abscess caused by Gordonia bronchialis and the use of 16s rRNA gene sequence analysis for its definitive identification

“…(Werno et al, 2005). Many patients, as in our case, require 6-12 weeks of therapy with different antibiotics, often along with appropriate surgical debridement (Johnson et al, 2011;Siddiqui et al, 2012;Sng et al, 2004;Werno et al, 2005). This prolonged course could be explained by the ability of Gordonia spp.…”

Recurrent Breast Abscess Caused by Gordonia bronchialis in an Immunocompetent Patient

“…The isolate was initially incorrectly identified as a Rhodococcus sp. by a commercial identification system (API Coryne, bioMérieux) with the API code 1111104, a misidentification that has been previously reported (11). Biochemically, the isolate was positive for catalase, nitrate, and urease.…”