Brevibacterium paucivorans bacteremia: case report and review of the literature

Abstract

Background Brevibacteria are obligate aerobic gram-positive rods that are associated with milk products and are also found on human skin. Brevibacterium has been reported as a rare cause of catheter related blood steam infection mainly in immunocompromised hosts such as malignancies or AIDS patients. Case presentation A 94-year old woman, which had a past history of diabetes mellitus and chronic heart failure, presented with high fever associated with decreased oral intake and appetite loss and was admitted to our institute. A physical examination at the time of presentation was unremarkable. On day 2, both blood cultures collected on admission became positive with coryneform organism within 24 h without Staphylococci and Brevibacterium species were identified by Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Subsequently, genetic investigation by 16S ribosomal RNA analysis was performed in order to identify the organism. Finally, the result identified this pathogen as Brevibacterium paucivorans with 99.5% homology on the Ez taxon database. The patient was started empirically on meropenem and teicoplanin for broad-spectrum antibiotic coverage. The patient’s fever finally abated and labs were also improved. On day 14, the antibiotic therapy was discontinued. The site of infections was unknown. We hereby report a case of Brevibacterium paicivorans bacteremia in an immunocompetent patient and review cases of Brevibacterium specises bacteremia previously reported. This is the first case of B. paucivorans bacteremia as far as we could search. Conclusion Physicians and microbiologists should be aware that Brevibacteria are uncommon but important agents which could cause opportunistic infections in immunocompetent.

Brevibacteria tibial osteomyelitis

“…Brevibacterium species were thought to be apathogenic until 1991, when the first case of sepsis due to B. epidermidis central line-associated blood stream infection was reported by McCaughey [ 2 ]. Since that time, at least 18 total case reports have implicated Brevibacterium species in human disease ( Table 1 ) [ [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] ]. B. casei is the most frequent species isolated from clinical specimens [ 1 ].…”

Draft whole-genome sequence of Brevibacterium casei strain isolated from a bloodstream infection

“…The detection of the beta-lactamase blaTEM-116 encoding gene most probably corresponding to the identified phenotypic resistance against penicillin G has drawn our particular attention. Although B. casei has been reported to be uniformly sensitive to tetracycline, gentamicin, glycopeptides, and rifampin [2,3,5,6,25], decreased susceptibility of the species to beta-lactam agents or clindamycin has been described in previous publications [2,6,26].…”

“…suffering from severe underlying diseases such as malignancies or endocarditis. Important risk factors for Brevibacterium infections include indwelling foreign materials, prosthetic heart valves, or continuous ambulatory peritoneal dialysis catheters [2][3][4][5][6].…”

“…According to the available literature data, Brevibacteria are uncommon but important opportunistic pathogens. Starting from 1991, 15 cases of bacteremia caused by this group of bacteria have been reported [3,5,6,[13][14][15][16][17][18][19][20][21][22][23]. The predominant species, responsible for 10 out of 15 cases, was B. casei.…”

“…The predominant species, responsible for 10 out of 15 cases, was B. casei. Single reported bacteremia cases were caused by other species including B. epidermidis [13], Brevibacterium massiliense [23] now designated as Brevibacterium ravenspurgense [24], and Brevibacterium paucivorans [6] whereas in the two remaining reports, the isolate could not be characterized to the species level. The overwhelming majority of patients reported in the publications cited above suffered from severe underlying conditions including malignancies, AIDS, Crohn's disease, pulmonary hypertension, diabetes, and chronic heart failure.…”