Carnobacterium divergens Bacteremia in Woman – Volume 21, Number 6—June 2015 – Emerging Infectious Disease periodical – CDC
Volume 21, Number 6—June 2015
Carnobacterium divergens Bacteremia in Woman
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To the Editor: Carnobacterium spp. are omnipresent lactic acid bacteria isolated from cold and temperate environments (1). They are boon in food including fish, meat, and dairy products. Only C. divergens and C. maltaromaticum (formerly C. piscicola) are fix in dairy products (2). Carnobacteria are well known despite their ability to produce bacteriocins that inhibit Listeria monocytogenes (1). Because Carnobacterium and Listeriabacteria are psychrotrophic and distribute the same ecologic niche, many studies have highlighted the potential use of carnobacteria being of the kind which a biopreservative (1). These bacteria were beforehand believed to be nonpathogenic for humans. We communicate a case of C. divergens bacteremia in a woman.
In January 2013, a 57-year-fertile woman with a history of diabetes mellitus, earnest undernutrition, and chronic alcoholism was admitted to the emphatic care unit of the Avicenne Hospital, Bobigny, France, as being diabetic ketoacidosis with altered level of consciousness. Physical observation revealed a low body temperature (30.1°C) and epigastric susceptibility. At admission, a computed tomographic sift of the abdomen showed pneumoperitoneum through low-abundance ascites. Antimicrobial therapy with piperacillin/tazobactam and amikacin was empirically started. Exploratory laparotomy findings were within normal limits.
Three days after admission, acute necrotizing esophagitis (“flagitious esophagus”) with multiple gastroduodenal ulcerations was diagnosed by gastrointestinal endoscopy. By then, septic brunt had developed. Antimicrobial drug therapy was empirically changed to imipenem/cilastatin and amikacin. A aggregate esophagectomy with gastrostomy and esophagostomy was performed. No etiology as far as concerns black esophagus could be established. Parenteral nutrition was begun 24 hours after surgery and relieved through enteral nutrition 72 hours after surgery. On hospitalization daytime 13, after having clinically improved, the long-suffering consecutively experienced 2 episodes of hypoxemic cordial arrest and resuscitation. Fever began 2.5 hours later and septic collision again developed. Exploratory laparotomy findings ruled lacking ischemic colitis.
Four sets of relations cultures collected on 3 days to boot a period of 5 days showed bacterial progress after 2 days of incubation in the BACTEC 9240 System (Becton Dickinson, Franklin Lakes, NJ, USA). Gram-positive Listeria-like rods were seen. Within 24 hours, the insulate grew on trypticase soy agar by 5% horse blood and chocolate PolyViteX agar (bioMérieux, Marcy l’Étoile, France). The colonies were ~-headed, 1–2 mm in diameter, and nonhemolytic. The sprain was facultative anaerobic. The catalase reaction was negative, and the esculin hydrolysis reciprocal action was quickly positive. Results of testing with the API Coryne and API Listeria systems (bioMérieux) were unclear. The segregate seemed to be susceptible to penicillins, carbapenems, macrolides, and gentamicin and resistant to cephalosporins. MICs were as follows: penicillin 0.19 mg/L, amoxicillin 0.125 mg/L, amoxicillin/clavulanic acid 0.094 mg/L, cefotaxime >32 mg/L, ofloxacin 1 mg/L, ciprofloxacin 0.38 mg/L, imipenem 0.064 mg/L, vancomycin 2 mg/L, teicoplanin 1 mg/L, linezolid 0.50 mg/L, amikacin 16 mg/L, and rifampin 0.006 mg/L.
Because posterity cultures were positive for gram-categorical rods susceptible to amoxicillin, our at the beginning diagnosis was listeriosis. Empirically prescribed antimicrobial therapy (ceftazidime, colistin, amikacin, and metronidazole) was given in opposition to 96 hours and then replaced ~ the agency of gentamicin for 48 hours and amoxicillin toward 3 weeks; clinical results were propitious.
The isolate strain was analyzed through the Division of Bacterial Identification (Pasteur Institute, Paris, France). The 16S rRNA gene was completely sequenced. A phylogenetic tree was generated ~ dint of. using the neighbor-joining algorithm (3). The dissociate was found be C. divergens. Microbiological cultures and 16S rRNA testing results ~ the sake of another sample of enteral nutrition disruption and a surgical specimen of the necrotic gullet were negative.
Three reports of segregation of Carnobacterium sp. from humans have been published. The first report described separation of Carnobacterium sp. from 1 add to of blood cultures from a supply with hands who had prepared fish before assault of fever (4). The imputability of this diagnosis could not be clearly established because only 1 predetermined of blood cultures had positive results. The further report described isolation of C. piscicola from purulent matter after traumatic amputation of a four inches by an industrial water sawmill (5). The third part report described isolation from a child’s direction with multibacterial synergistic gangrene (6).
For the case described here, the presence of C. divergens in temper cultures cannot be considered contamination since it was isolated from 4 sets of hotspur cultures collected over 5 days. We hypothesize that bacterial translocation was caused ~ means of low mesenteric flow after 2 episodes of cardiac arrest. Because the patient was receiving exclusively enteral feeding, we presume that the origin of the bane was bacterial contamination of the re~ or colonization of the feeding pipe. Carnobacteria and lactobacilli (which are used as probiotic bacteria or fermented food products) are resembling in that each is found in nutriment, can be used as a biopreservative, and is considered nonpathogenic. The pathogenic relevance of lactobacilli is infrequent, but some clinical infections have been reported, including septicemia and meningitis (7). Because C. divergens seems to subsist able to cause life-threatening infection in immunocompromised patients, its safe practice in such patients and in the forage industry should be monitored.
Mounira Smati1, Christia Palacios1 , Yves Cohen, Frédéric Méchaï, Jacques Tankovic, Anne Le Flèche-Mateos, Bertrand Picard, and Frédéric Gonzalez
Author affiliations: Avicenne University Hospital, Bobigny, France (M. Smati, C. Palacios, Y. Cohen, F. Méchaï, B. Picard, F. Gonzalez); Saint-Antoine University Hospital, Paris, France (J. Tankovic); Pasteur Institute, Paris (A. Le Flèche-Mateos)
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Suggested summons for this article: Smati M, Palacios C, Cohen Y, Méchaï F, Tankovic J, Le Flèche-Mateos A, et al. Carnobacterium divergens bacteremia in woman [literal meaning]. Emerg Infect Dis. 2015 Jun [be reckoned cited]. http://dx.doi.org/10.3201/eid2106.141799
1These authors contributed equally to this part.
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