Globicatella sanguinis Meningitis Associated with Human Carriage

Abstract

Globicatella sanguinis is a rare cause of acute meningitis. We demonstrated human carriage of Globicatella by identifying cefotaxime-resistant strains in groin and rectal specimens 9 months after invasive infection. The pathogenic strain isolated from the cerebrospinal fluid and the carriage strains were accurately identified by sodA gene sequence analysis. CASE REPORTA 56-year-old woman presented with vomiting and headache, associated with instability when walking, memory impairment, and clinical signs of meningitis. Lumbar puncture revealed turbid cerebrospinal fluid (CSF) with pleocytosis (11,800 ϫ 10 6 white blood cells/liter with 94% polymorphonuclear cells), a glucose concentration of 0.59 g/liter, and a protein concentration of 2.32 g/liter. Gram-positive cocci were observed and subsequently identified as Globicatella sanguinis strain HDP50220. Based on the results of antibiotic susceptibility tests, the primary antibiotic treatment, which consisted of cefotaxime (100 mg/kg of body weight/day intravenously [i.v.]) combined with fosfomycin (200 mg/kg/day i.v.), was replaced by amoxicillin (200 mg/kg/day i.v.) for 3 weeks. Remission of meningitis was confirmed by the absence of bacterial growth from a follow-up CSF sample. Nine months later, Globicatella isolates HDP60616 and HDP60617 were retrieved from the groin and rectum, respectively.The Globicatella strain from CSF grew as pinpoint, alphahemolytic colonies on blood and chocolate agars (Oxoid, Wesel, Germany) incubated for 18 h at 37°C under an atmosphere enriched with 5% CO 2 ; Gram-positive, catalase-negative cocci organized into short chains and clusters were observed. Biochemical characteristics of the strain determined by the rapid ID 32 Strep system corresponded to those of G. sanguinis (profile 623.761.733.50; certainty of 99.9%), whereas those determined by the API 20 Strep system corresponded to those of Aerococcus viridans (profile 7306773; certainty of 88.9%) (both systems were obtained from bioMérieux, Marcy l'Etoile, France) ( Table 1).The antibiotic susceptibility of the isolate was investigated by the disk diffusion method, and MICs were determined with the Etest (AES, Combourg, France). The criteria of the Antibiogram Committee of the French Society for Microbiology for Streptococcus spp. were used for the interpretation of antimicrobial drug susceptibility results (http://www.sfm.asso.fr). The strain was susceptible to benzylpenicillin (MIC ϭ 0.125 g/ml), amoxicillin (MIC Յ 0.016 g/ml), chloramphenicol, tetracycline, pristinamycin, rifampin, fosfomycin, vancomycin, and teicoplanin and resistant to cefotaxime (MIC Ն 32 g/ml), erythromycin (MIC ϭ 32 g/ml), and clindamycin (MIC Ն 256 g/ml). The isolate was tested for the presence of the mefA, ermB, and ermA genes by multiplex PCR as described previously (7, 9). An amplification product from ermA, but not from the other genes, was obtained. Swab samples from the nasal fossae, throat, armpit, groin, and rectum were plated onto colistin-nalidixic acid-blood agar plates (Oxoid) for the invest...

Globicatella sanguinisBacteremia in a Korean Patient

“…It is difficult to explain that most cases of G. sanguinis infection, including this case, were revealed from aged female patients [5,9,10,12,13]. G. sanguinis would infect stockbreeding animals and farmer but actual pathway of infection was unknown [9,12]. In usual, G. sanguinis had high MIC level against 3 rd generation cephalosporin, which was used popularly as empirical antibiotics, but low MIC level against penicillin [2,12].…”

Globicatella sanguinis: reporte de un caso de meningitis en el Hospital Militar Central

“…La paciente muestra signos de control de la respuesta inflamatoria sistémica tres días después del inicio de antibiticoterapia, también disminución de signos de hipertensión intracraneal. No se encuentran microrganismo en muestras de LCR posteriores al tratamiento con antibióticos, razón por la cual no se realiza nuevo kit API Strep® Discusión G. sanguinis es un coco Gram positivo, α hemolítico, catalasa negativa (4,(6)(7)(8), no móvil, morfología microscópica de forma ovoide, capaz de formar cadenas cortas y colonias puntiformes en medios de cultivo sólidos para microorganismos exigentes (agar chocolate) y como característica destacada en cuanto a su espectro de resistencia muestra sensibilidad a Glicopeptidos (9). Crece a temperaturas entre 10°C a 45°C, en medio anaerobio con agar chocolate enriquecido con CO 2 al 5%, bilis esculina, solución salina al 6,5% (4,6).…”

“…Ambas especies se han reportado como agentes infecciosos de animales y en seres humanos, asilándose en pacientes con bacteremia, infecciones del tracto urinario y del sistema REVISTA 25(1): 2017 Globicatella sanguinis: reporte de caso de Meningitis nervioso central en seres humanos (2,4,9). Sin embargo, se ha demostrado que G. sanguinis puede ser parte de la flora a nivel del recto y la ingle comportándose como un microorganismo comensal, ya que se ha asilado en pacientes con ausencia de síntomas, lo que sugiere que puede ser un reservorio (3,8,9), documentándose además su capacidad como microorganismo oportunista en pacientes inmunosuprimidos, en quienes produce cuadros de meningoencefalitis e incluso en abscesos cerebrales (2).…”

“…Según la literatura, el cuadro clínico secundario a la meningitis por G. sanguinis consiste en fiebre, vomito, cefalea, alteración en la marcha, nistagmus, pérdida del apetito, y ataxia afectando a los pacientes en los extremos de la vida (6,(9)(10)(11)(12). Se evidencia además pleiocitosis a expensas de neutrófilos acompañado de una extracción de líquido cefaloraquideo de características turbias, con proteinoraquia (8,9).…”

“…Se evidencia además pleiocitosis a expensas de neutrófilos acompañado de una extracción de líquido cefaloraquideo de características turbias, con proteinoraquia (8,9). En este caso la paciente presentaba la mayoría de los elementos diagnósticos nombrados anteriormente; estos hallazgos no son muy diferentes de otras meningitis y por si mismos no son suficientes para realizar un análisis acertado (11), si a esto se le suma la gran similitud de las pruebas bioquímicas usuales de otros microorganismos (especialmente St. viridans), se encuentra un diagnostico complicado, que amerita pruebas de alta especificidad como Api Strep® (99.9%) (9).…”