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Actinomyces gerencseriae hip prosthesis infection: a case report.

Dubourg G, Delord M, Gouriet F, Fournier PE, Drancourt M - J Med Case Rep (2015)

Bottom Line: Actinomyces bacteria are part of the human oropharyngeal microbiota.Culturing a fluid sample from the collection puncture found Staphylococcus hominis and a Gram-positive bacillus unidentified by matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF).Sequencing the 16S rRNA gene amplified from both the specimen and the isolate identified A. gerencseriae.

View Article: PubMed Central - PubMed

Affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France. greg.dubourg@gmail.com.

ABSTRACT

Introduction: Actinomyces bacteria are part of the human oropharyngeal microbiota. They have been associated with abdominal, cervicofacial and thoracic infections and a few cases of joint infections have also been described. In particular, Actinomyces gerencseriae, formerly described as Actinomyces israelii serovar II, has rarely been associated with human infections, mostly involving cervicofacial lesions and periodontal diseases. Here, we report one case of hip prosthesis infection due to A. gerencseriae.

Case presentation: A 72-year-old Caucasian male developed an inflammatory collection on the outside of the right thigh where a hip prosthesis had been implanted for 11 years. Culturing a fluid sample from the collection puncture found Staphylococcus hominis and a Gram-positive bacillus unidentified by matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF). Sequencing the 16S rRNA gene amplified from both the specimen and the isolate identified A. gerencseriae. Treatment adjusted with amoxicillin and trimethropim-sulfamethoxazole cured the infection.

Conclusion: The recently described A. gerencseriae has rarely been involved in human infections. We report the first case of A. gerencseriae joint infection in a hip prosthesis.

No MeSH data available.


Related in: MedlinePlus

Gel view comparing A. genrencseriae strain URMITE (= CSUR P1401). The gel view displays the raw spectra of loaded spectrum files arranged in a pseudo-gel like look. The x-axis records the m/z value. The left y-axis displays the running spectrum number originating from subsequent spectra loading. Peak intensity is expressed by a greyscale code. The color bar and the right y-axis indicate the relation between the peak color displayed and peak intensity in arbitrary units. Displayed species are indicated on the left, while the URMITE strain is highlighted as blue
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Fig2: Gel view comparing A. genrencseriae strain URMITE (= CSUR P1401). The gel view displays the raw spectra of loaded spectrum files arranged in a pseudo-gel like look. The x-axis records the m/z value. The left y-axis displays the running spectrum number originating from subsequent spectra loading. Peak intensity is expressed by a greyscale code. The color bar and the right y-axis indicate the relation between the peak color displayed and peak intensity in arbitrary units. Displayed species are indicated on the left, while the URMITE strain is highlighted as blue

Mentions: At the same time, he was diagnosed with fistulization of the infected iliopsoas hematoma on the outside of the right thigh, which had been neglected in view of other intercurrent medical episodes. This was subsequently treated for eight weeks by amoxicillin-clavulanate and fusidic acid without microbiological documentation. Four months later, the right hip collection persisted and an incision with drainage was conducted. Several PCR tests, including 16S rRNA gene amplification [13] performed on the sampled fluid, were negative and the standard culture was sterile. At that time, the white blood cell count was normal at 8.4×109/L (the neutrophil count was 6.2×109/L) and the platelet count was 246×109/L. The erythrocyte sedimentation rate was elevated at 82mm/hour. A second specimen, sampled eight weeks later, grew two types of colonies on Columbia agar with 5% sheep blood (bioMérieux, Marne la Coquette, France) incubated at 37°C in a 5% CO2-enriched and anaerobic atmosphere. Matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF-MS) [14], that allows bacterial identification through their mass spectra, identified one colony as Staphylococcus hominis with an identification score of 2.02. However, MALDI-TOF-MS identification of the second colony failed. This Gram-positive bacillus was then identified by PCR-sequencing of the 16S rRNA gene as previously described [13]. A 1,486-bp sequence (GenBank LN624398) yielded 99.2% similarity with A. gerencseriae (Genbank X80414) using NCBI BLAST (http://www.ncbi.nlm.nih.gov). This isolate was deposited in the Collection de Souches de l’Unité des Rickettsies (=CSUR P1401). This A. gerencseriae MALDI-TOF-MS spectrum was subsequently added to the database (Fig. 1) in order to be specifically compared to eight other Actinomyces spectra available in the database (Fig. 2). Further amplification and sequencing of the 16S rRNA gene directly on the sampled fluid yielded a 999-bp sequence exhibiting 98.9% sequence similarity with A. gerencseriae (Genbank NR029280) and 99.7% sequence similarity with that of the isolate (GenBank LN624398). The antibiotic regimen was adapted with amoxicillin and trimethoprim-sulfamethoxazole after the minimum inhibitory concentrations had been measured at 0.023mg/L and <1mg/L, respectively. This treatment was stopped three weeks later due to kidney failure. Further microbiological investigation found Staphylococcus aureus and ofloxacin combined with rifampicin was finally prescribed.Fig. 1


Actinomyces gerencseriae hip prosthesis infection: a case report.

Dubourg G, Delord M, Gouriet F, Fournier PE, Drancourt M - J Med Case Rep (2015)

Gel view comparing A. genrencseriae strain URMITE (= CSUR P1401). The gel view displays the raw spectra of loaded spectrum files arranged in a pseudo-gel like look. The x-axis records the m/z value. The left y-axis displays the running spectrum number originating from subsequent spectra loading. Peak intensity is expressed by a greyscale code. The color bar and the right y-axis indicate the relation between the peak color displayed and peak intensity in arbitrary units. Displayed species are indicated on the left, while the URMITE strain is highlighted as blue
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4587881&req=5

Fig2: Gel view comparing A. genrencseriae strain URMITE (= CSUR P1401). The gel view displays the raw spectra of loaded spectrum files arranged in a pseudo-gel like look. The x-axis records the m/z value. The left y-axis displays the running spectrum number originating from subsequent spectra loading. Peak intensity is expressed by a greyscale code. The color bar and the right y-axis indicate the relation between the peak color displayed and peak intensity in arbitrary units. Displayed species are indicated on the left, while the URMITE strain is highlighted as blue
Mentions: At the same time, he was diagnosed with fistulization of the infected iliopsoas hematoma on the outside of the right thigh, which had been neglected in view of other intercurrent medical episodes. This was subsequently treated for eight weeks by amoxicillin-clavulanate and fusidic acid without microbiological documentation. Four months later, the right hip collection persisted and an incision with drainage was conducted. Several PCR tests, including 16S rRNA gene amplification [13] performed on the sampled fluid, were negative and the standard culture was sterile. At that time, the white blood cell count was normal at 8.4×109/L (the neutrophil count was 6.2×109/L) and the platelet count was 246×109/L. The erythrocyte sedimentation rate was elevated at 82mm/hour. A second specimen, sampled eight weeks later, grew two types of colonies on Columbia agar with 5% sheep blood (bioMérieux, Marne la Coquette, France) incubated at 37°C in a 5% CO2-enriched and anaerobic atmosphere. Matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF-MS) [14], that allows bacterial identification through their mass spectra, identified one colony as Staphylococcus hominis with an identification score of 2.02. However, MALDI-TOF-MS identification of the second colony failed. This Gram-positive bacillus was then identified by PCR-sequencing of the 16S rRNA gene as previously described [13]. A 1,486-bp sequence (GenBank LN624398) yielded 99.2% similarity with A. gerencseriae (Genbank X80414) using NCBI BLAST (http://www.ncbi.nlm.nih.gov). This isolate was deposited in the Collection de Souches de l’Unité des Rickettsies (=CSUR P1401). This A. gerencseriae MALDI-TOF-MS spectrum was subsequently added to the database (Fig. 1) in order to be specifically compared to eight other Actinomyces spectra available in the database (Fig. 2). Further amplification and sequencing of the 16S rRNA gene directly on the sampled fluid yielded a 999-bp sequence exhibiting 98.9% sequence similarity with A. gerencseriae (Genbank NR029280) and 99.7% sequence similarity with that of the isolate (GenBank LN624398). The antibiotic regimen was adapted with amoxicillin and trimethoprim-sulfamethoxazole after the minimum inhibitory concentrations had been measured at 0.023mg/L and <1mg/L, respectively. This treatment was stopped three weeks later due to kidney failure. Further microbiological investigation found Staphylococcus aureus and ofloxacin combined with rifampicin was finally prescribed.Fig. 1

Bottom Line: Actinomyces bacteria are part of the human oropharyngeal microbiota.Culturing a fluid sample from the collection puncture found Staphylococcus hominis and a Gram-positive bacillus unidentified by matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF).Sequencing the 16S rRNA gene amplified from both the specimen and the isolate identified A. gerencseriae.

View Article: PubMed Central - PubMed

Affiliation: Aix Marseille Université, URMITE, UM63, CNRS 7278, IRD 198, Inserm 1095, 13005, Marseille, France. greg.dubourg@gmail.com.

ABSTRACT

Introduction: Actinomyces bacteria are part of the human oropharyngeal microbiota. They have been associated with abdominal, cervicofacial and thoracic infections and a few cases of joint infections have also been described. In particular, Actinomyces gerencseriae, formerly described as Actinomyces israelii serovar II, has rarely been associated with human infections, mostly involving cervicofacial lesions and periodontal diseases. Here, we report one case of hip prosthesis infection due to A. gerencseriae.

Case presentation: A 72-year-old Caucasian male developed an inflammatory collection on the outside of the right thigh where a hip prosthesis had been implanted for 11 years. Culturing a fluid sample from the collection puncture found Staphylococcus hominis and a Gram-positive bacillus unidentified by matrix-assisted laser desorption ionization time-of-flight mass-spectrometry (MALDI-TOF). Sequencing the 16S rRNA gene amplified from both the specimen and the isolate identified A. gerencseriae. Treatment adjusted with amoxicillin and trimethropim-sulfamethoxazole cured the infection.

Conclusion: The recently described A. gerencseriae has rarely been involved in human infections. We report the first case of A. gerencseriae joint infection in a hip prosthesis.

No MeSH data available.


Related in: MedlinePlus