Clinical illnesses associated with isolation of dysgonic fermenter 3 from stool samples

Abstract

The clinical significance of the fastidious organism DF-3 isolated from stool cultures is unclear. We sought to improve our understanding of this organism and to further define its association with human disease. Stool cultures for DF-3 were obtained from three sources: an ongoing study of enteric pathogens in patients infected with the human immunodeficiency virus, a screening procedure in which all stool samples submitted for Clostridium difficile toxin assay were cultured for DF-3, and stool samples submitted specifically for DF-3 culture. Retrospective clinical data were obtained from chart reviews of patients with positive cultures. Antimicrobial susceptibility testing and cell wall fatty acid analysis were performed for each DF-3 isolated. Eight isolates of DF-3 were obtained over a period of 8 months. All patients either had severe underlying disease or were immunocompromised, including three patients coinfected with human immunodeficiency virus and two patients with inflammatory bowel disease. The spectrum of clinical disease ranged from chronic diarrhea with a well-defined response to therapy for DF-3 to an asymptomatic carrier state. Cell wall fatty acid analysis of these isolates demonstrated a consistent pattern with a large peak of 12-methyltetradecanoate. DF-3, a fastidious gram-negative coccobacillus, can be recovered from stool cultures of immunocompromised patients

Septicemia Caused by Dysgonic Fermenter 3 in a Severely Immunocompromised Patient and Isolation of the Same Microorganism from a Stool Specimen

“…Metabolic fatty acids produced by the blood isolate were propionic, lactic, and succinic acids, and the major cellular fatty acids were a-C 15:0 (26%), i-3-OH-C 16:0 (21%), i-C 14:0 (13%), 3-OH-C 16:0 (6%), C 16:0 (5%), i-C 15:0 (4%), C 15:0 (3%), C 16:17c (3%), and C 18:19c (3%). In line with previous results (1,2,4), the blood isolate was susceptible to amoxicillin-clavulanate, clindamycin, erythromycin, piperacillin-tazobactam, rifampin, tetracycline, and trimethoprim-sulfamethoxazole (Table 1). Pulsed-field gel electrophoresis did not reveal visible bands in any run.…”

Clinical isolation of a DF-3 microorganism and review of the literature

“…DF‐3 microorganisms are particularly resistant to antimicrobials, and almost uniform resistance has been described to aminoglycosides, quinolones and all β‐lactams, except for imipenem, which showed variable activity [6,7]. In our case both imipenem and meropenem showed MICs >32 mg/L by E‐test (AB Biodisk.…”

“…DF‐3 has recently been associated with human disease, mainly chronic diarrhea [6–9]. We were able to find 10 cases of diarrhea purportedly caused by DF‐3.…”

“…We were able to find 10 cases of diarrhea purportedly caused by DF‐3. However, when a systematic search was performed in stool samples, DF‐3 was present in 1.1–2.3% of all the specimens, but was considered to be a cause of diarrhea in less than half of them [6,7]. The extra‐intestinal presence of DF‐3 is even more uncommon, and has been reported as being responsible for cases of bacteremia [10], soft tissue infection [11,13] and urinary tract infection [12] (Table 3).…”

Recovery of uncommon bacteria from blood: association with neoplastic disease

“…Hickling et al (144) reviewed 41 cases of DF-2 infection and noted five cases of cancer: three cases of Hodgkin's disease and two cases of chronic lymphocytic leukemia. There appears to The unnamed Capnocytophaga species called DF-3 has been shown in some studies (25,118,311) to be associated with gastrointestinal disease. Gill et al (118) showed that 1.6% (11 of 690 cultures) of stool cultures were positive for DF-3.…”