The first case of urosepsis caused by Corynebacterium aurimucosum in an immunocompetent patient.

Non-diphtheroid Corynebacterium sepsis is rare and has affected only immunocompromised or particularly predisposed patients so far. We present the first case of urosepsis caused by Corynebacterium aurimucosum in a 67-year-old woman, without any known immunodeficiencies and in absence of any immunosuppressive therapy, admitted to the hospital for fever and acute dyspnea. This work suggests a new approach in evaluating the isolation of Corynebacteria, especially if isolated from blood. In particular, it highlights the potential infectious role of C. aurimucosum (often considered a contaminant and only rarely identified as an etiological agent of infections) and its clinical consequences, detailing also interesting aspects about its microbiological diagnosis and relative therapy and clarifying contrasting data of literature.

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[Pyogenic spondylitis after Corynebacterium striatum blood stream infection following allogeneic hematopoietic stem cell transplantation for malignant lymphoma].

Patient 1 was a 70-year-old woman with refractory diffuse large B-cell lymphoma who received allogeneic peripheral blood stem cell transplantation from an HLA-haploidentical related donor. Upper back pain appeared on day63, and Th8-Th9 pyogenic spondylitis was diagnosed based on magnetic resonance imaging (MRI). Blood culture on day14 identified Corynebacterium striatum as the causative bacteria of blood stream infection (BSI). The pyogenic spondylitis resolved after treatment with daptomycin for 2 months. Patient 2 was a 65-year-old man with relapsed angioimmunoblastic T-cell lymphoma who received bone marrow transplantation from an HLA-DR single-antigen-mismatched unrelated donor. Lower back pain appeared on day30, and L4-L5 pyogenic spondylitis was diagnosed based on MRI. Blood culture was negative. Daptomycin and clindamycin were selected for treatment based on the drug susceptibility of bacteria that had caused pre-engraftment BSI (Escherichia coli on day3 and Corynebacterium striatum on day9), and the pyogenic spondylitis resolved after 6 months of this treatment. Pyogenic spondylitis should be considered in the differential diagnosis of back pain accompanied by BSI before engraftment in allogeneic hematopoietic stem cell transplant recipients.

A Case Report of Corynebacterium Tuberculostearicum Infection.

BACKGROUND: The goal was to report a rare case of lymphadenitis caused by Corynebacterium tuberculostearicum, and the laboratory's coping approach in the isolation and identification of this rare pathogen to improve the understanding of the disease. METHODS: Lymph node biopsy was performed in a patient with suspected tuberculous lymphadenitis, and the biopsy tissue was isolated and cultured. RESULTS: The culture was Gram positive Corynebacterium, which was identified as Corynebacterium tuberculostearicum by microbial mass spectrometry and 16S rRNA gene sequencing. Antimicrobial susceptibility test showed that the drug was sensitive to daptomycin, doxycycline, gentamicin, linezolid, vancomycin, and meropenem, but resistant to ciprofloxacin, clindamycin, erythromycin, rifampicin, compound sulfamethoxazole, ceftriaxone, and cefepime. CONCLUSIONS: This is a case of Corynebacterium tuberculostearicum infection. Case reports of Corynebacterium tuberculostearicum infection are relatively rare in China. Through case study, we can provide help for laboratory isolation, identification, clinical diagnosis, and treatment.

Corynebacterium bacteremia in patients with hematologic disorders: a case series and systematic literature review.

Corynebacterium is generally considered a contaminant in clinical practice. However, it may cause bacteremia in patients with hematologic disorders, and factors that contribute to its mortality are unclear. A case series and systematic literature review identified 96 cases of Corynebacterium bacteremia inhematologic disorderpatients. The median age was 50.5 years (range: 2-93 years), with 79 (82%) patients 18 years or older, and 64 (67%) patients male. Most cases involved hematologic malignancies, and neutropenia was observed in approximately 75% cases. The most common sites of infection/symptoms were skin and soft tissue, respiratory, and catheter-related bloodstream infection. The infection-related mortality was 23%, and univariate analysis showed that age, respiratory infection/symptoms, and source control were significantly associated with infection-related mortality. Multivariate analysis indicates that infection-related mortality was significantly reduced by source control (OR: 0.24, 95% CI: 0.06-0.97, p = 0.046). Therefore, when Corynebacterium infections are suspected, early source control should be considered.

Infective endocarditis and septic arthritis caused by Corynebacteriumstriatum.

Corynebacterium striatum occasionally causes nosocomial infections, such as catheter-related bloodstream infection and pneumonia; however, C. striatum-related infective endocarditis or septic arthritis is uncommon. We present the case of an 85-year-old woman with infective endocarditis at the native valve and septic arthritis at the native shoulder joint caused by C. striatum. The patient was admitted for a 10-day history of fever and right shoulder pain. She had no history of artificial device implantation, injury, arthrocentesis, or hospitalization. A physical examination revealed conjunctival petechiae, a systolic heart murmur, and right shoulder joint swelling. C. striatum was observed in two blood culture sets. Transesophageal echocardiography revealed vegetation in the right aortic coronary cusp. Arthrocentesis at the right shoulder aspirated pyogenic fluid and C. striatum was detected in the culture. The patient was diagnosed with infective endocarditis and septic arthritis caused by C. striatum, and ampicillin was administered based on antimicrobial susceptibility test results. The patient's condition was initially stable; however, she developed pulmonary congestion on day 56 and eventually died. An autopsy demonstrated perforation of the aortic left coronary cusp with vegetation. C. striatum may cause native valve endocarditis and native joint septic arthritis.

Encrusted cystitis caused by corynebacterium urealyticum: a case report with novel treatment strategy of intravesical dimethyl sulfoxide

ABSTRACT Encrusted cystitis (EC) was first described as chronic cystitis with mucosal calcification in 1914 (1). It is a very rare chronic inflammatory disease presenting with dysuria, pelvic pain and gross hematuria. Voided urine contains mucus or calcified mucopurulent stone like particles. Urinalysis always reveals alkaline pH. It may be present in healthy individuals with no predisposing etiological factors (2-4). Etiologically, previous urological diseases, immunosuppression, urinary infection with urea splitting bacteria, or urological interventions resulting in bladder mucosa trauma may also be present (5, 6). In the present case report, we describe a novel treatment for EC with intravesical dimethyl sulfoxide.

Tricomicosis (tricobacteriosis) en un infante: aspectos microbiológicos, dermatoscópicos y ultraestructurales / Trichomycosis (trichobacteriosis) capitis in an infant: microbiological, dermoscopic and ultrastructural features

La tricomicosis es una infección superficial causada por Corynebacterium flavescens, que afecta por lo regular pelos axilares, en menor grado los púbicos, los escrotales e interglúteos y excepcionalmente los de la cabeza o tricomicosis capitis (TC). Esta infección se caracteriza por formación de nódulos pilosos. Clínicamente se confunde con infecciones como piedra blanca y pediculosis. El diagnóstico se realiza por microscopia y dermatoscopia de masas bacterianas y confirmado por cultivo. OBJETIVO: Presentar un caso de TC en un infante, y mostrar las características microscópicas, dermatoscópicas y ultraestructurales. CASO CLÍNICO: Niño sano de 6 meses de edad, con dermatosis que afectó los pelos de la cabeza en forma de múltiples nódulos-pilosos amarillentos. Se comprobó TC mediante fluorescencia amarilla a la luz de Wood; a la dermatoscopia se observaron cadenas blanco-amarillentas, como "rosarios de piedras cristalinas"; al examen directo se distinguieron masas bacterianas y al cultivo se identificó Corynebacterium flavescens. A la microscopia electrónica se observó infección superficial, sin perforación de los pelos. Se realizó tratamiento con aplicación de ácido fusídico por 3 semanas y se obtuvo curación clínica y microbiológica. CONCLUSIÓN: La TC es una entidad rara que se presenta en niños, y que suele confundirse con otros padecimientos del pelo como la pediculosis e infecciones micóticas.

Trichomycosis is a superficial infection caused by Corynebacterium flavescens, which regularly affects axillary, and to a a lesser extent, pubic, scrotal and intergluteal, and exceptionally, head hairs or trichomycosis capitis (TC). This condition is characterised by the formation of bacterial nodules. Clinically, it can be confused with white piedra or pediculosis. The diagnosis is made by microscopic and dermoscopic observation and confirmed by culture. OBJECTIVE: To present a case of TC in an infant and illustrate the microscopic, dermoscopic, and ultrastructural characteristics. CLINICAL CASE: A 6 month-old boy, otherwise healthy, with multiple yellowish concretions on the hairs of the head. TC was confirmed by yellow fluorescence with Wood’s light; white-yellowish beads, like "rosaries of crystalline stones" were observed on dermoscopy, direct examination showed bacterial masses, and Corynebacterium flavescens was identified by culture. A superficial infection, without perforation of the hairs, was confirmed by electron microscopy. Treatment with fusidic acid for 3 weeks achieved a clinical and microbiological cure. CONCLUSION: TC is a rare condition that affects children, and tends to be mistaken for other diseases of the hair, such as pediculosis and mycotic infections.

MULTIPLE PULMONARY NODULES CAUSED BY Corynebacterium striatum IN AN IMMUNOCOMPETENT PATIENT / Nódulos pulmonares múltiplos causados por Corynebacterium striatum numa paciente imunocompetente

Nondiphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, however they rarely account for clinical infection. We present the first reported case of multiple pulmonary nodules caused by Corynebacterium striatum. The infection occurred in a 72-year-old immunocompetent female, and the diagnosis was obtained by Gram's stain and culture of lung biopsy. C. striatum should be recognized as a potential pathogen in both immunocompromised and normal hosts in the appropriate circumstances.

Bacilos não diftéricos são ubiquitários na natureza e comumente colonizam a pele e as membranas mucosas humanas, contudo eles raramente acarretam doença clínica. Apresentamos o primeiro relato de múltiplos nódulos causados por Corynebacterium striatum. A infecção ocorreu numa mulher imunocompetente de 72 anos de idade e o diagnóstico foi obtido pela coloração de Gram e cultivo de biópsia pulmonar. C. striatum deve ser reconhecido como potencial patógeno tanto em pacientes imunodeprimidos como em hospedeiros normais, em circunstâncias apropriadas.

Multiplex polymerase chain reaction to identify and determine the toxigenicity of Corynebacterium spp with zoonotic potential and an overview of human and animal infections

Corynebacterium diphtheriae, Corynebacterium ulcerans and Corynebacterium pseudotuberculosis constitute a group of potentially toxigenic microorganisms that are related to different infectious processes in animal and human hosts. Currently, there is a lack of information on the prevalence of disease caused by these pathogens, which is partially due to a reduction in the frequency of routine laboratory testing. In this study, a multiplex polymerase chain reaction (mPCR) assay that can simultaneously identify and determine the toxigenicity of these corynebacterial species with zoonotic potential was developed. This assay uses five primer pairs targeting the following genes: rpoB (Corynebacterium spp), 16S rRNA (C. ulcerans and C. pseudotuberculosis), pld (C. pseudotuberculosis), dtxR (C. diphtheriae) and tox [diphtheria toxin (DT) ]. In addition to describing this assay, we review the literature regarding the diseases caused by these pathogens. Of the 213 coryneform strains tested, the mPCR results for all toxigenic and non-toxigenic strains of C . diphtheriae, C. ulcerans and C. pseudotuberculosis were in 100% agreement with the results of standard biochemical tests and PCR-DT. As an alternative to conventional methods, due to its advantages of specificity and speed, the mPCR assay used in this study may successfully be applied for the diagnosis of human and/or animal diseases caused by potentially toxigenic corynebacterial species.

Trichobacteriosis: case report and dermoscopic study / Tricobacteriose: relato de caso e estudo dermatoscópico

The authors report a case of axillary trichobacteriosis in a 16 year-old patient whose complaints were bromhidrosis and hyperhidrosis axillaris. Although it can be diagnosed clinically, dermoscopy may be useful in some cases and reveal remarkable academic images.

Relata-se um caso de tricobacteriose axilar em paciente de 16 anos de idade cujas queixas eram de bromidrose e hiperidrose axilar. Embora a tricobacteriose possa ser diagnosticada clinicamente, a dermatoscopia pode ser útil em alguns casos e revelar imagens de extremo valor acadêmico.

Difteria pelo Corynebacterium ulcerans: uma zoonose emergente no Brasil e no mundo / Corynebacterium ulcerans diphtheria: an emerging zoonosis in Brazil and worldwide / Difteria por Corynebacterium ulcerans: una zoonosis emergente en Brasil y en el mundo

O artigo revisa a literatura sobre a emergência de infecções humanas causadas por Corynebacterium ulcerans em diversos países, incluindo o Brasil. Foi realizada análise de artigos publicados entre 1926 e 2011 nas bases Medline/PubMed e SciELO, bem como artigos e informes do Ministério da Saúde. Apresenta-se um esquema de triagem, rápido, econômico e de fácil execução, capaz de permitir a realização do diagnóstico presuntivo de C. ulcerans e C. diphtheriae na maioria dos laboratórios brasileiros públicos e privados. A circulação de C. ulcerans em vários países, aliada aos recentes casos de isolamento do patógeno no Rio de Janeiro, é um alerta a clínicos, veterinários e microbiologistas sobre a ocorrência de difteria zoonótica e a circulação do C. ulcerans em regiões urbanas e rurais do território nacional e/ou da América Latina.

The article is a literature review on the emergence of human infections caused by Corynebacterium ulcerans in many countries including Brazil. Articles in Medline/PubMed and SciELO databases published between 1926 and 2011 were reviewed, as well as articles and reports of the Brazilian Ministry of Health. It is presented a fast, cost-effective and easy to perform screening test for the presumptive diagnosis of C. ulcerans and C. diphtheriae infections in most Brazilian public and private laboratories. C. ulcerans spread in many countries and recent isolation of this pathogen in Rio de Janeiro, southeastern Brazil, is a warning to clinicians, veterinarians, and microbiologists on the occurrence of zoonotic diphtheria and C. ulcerans dissemination in urban and rural areas of Brazil and/or Latin America.

El articulo revisa la literatura sobre la emergencia de infecciones humanas causadas por Corynebacterium ulcerans en diversos países, incluyendo Brasil. Se realizó análisis de artículos publicados entre 1926 y 2011 en las bases Medline/Pubmed y SciELO, así como artículos e informes del Ministerio Brasileño de la Salud. Se presenta un esquema de selección, rápido, económico y de fácil ejecución, capaz de permitir la realización del diagnóstico presuntivo de C. ulcerans y C. diphtheriae en la mayoría de los laboratorios brasileños públicos y privados. La circulación de C. ulcerans en varios países, aliada a los recientes casos de aislamiento del patógeno en Rio de Janeiro (Sureste de Brasil), es un alerta a clínicos, veterinarios y microbiólogos sobre la ocurrencia de difteria zoológica y la circulación de C. ulcerans en regiones urbanas y rurales del territorio nacional y/o de América Latina.

Corynebacterium striatum infecting a malignant cutaneous lesion: the emergence of an opportunistic pathogen / Corynebacterium striatum infectando lesão cutânea maligna: a emergência de um patógeno oportunista

We described a case of a 27-year old male patient with skin and soft tissue infection of a neoplastic lesion caused by Corynebacterium striatum, an organism which has been rarely described as a human pathogen. Identification was confirmed by DNA sequencing. Successful treatment with penicillin was achieved. The role of the C. striatum as an emerging opportunistic pathogen is discussed.

Descrevemos infecção de lesão neoplásica em paciente masculino de 27 anos, envolvendo pele e partes moles, causada por Corynebacterium striatum, um microrganismo raramente descrito como patógeno humano. A identificação foi confirmada por seqüenciamento de DNA. O paciente foi tratado com penicilina, com sucesso. O papel do C. striatum como patógeno oportunista é discutido.

First detection of Corynebacterium ulcerans producing a diphtheria-like toxin in a case of human with pulmonary infection in the Rio de Janeiro metropolitan area, Brazil

The frequency and severity of human infections associated with Corynebacterium ulcerans appear to be increasing in different countries. Here, we describe the first C. ulcerans strain producing a diphtheria-like toxin isolated from an elderly woman with a fatal pulmonary infection and a history of leg skin ulcers in the Rio de Janeiro metropolitan area.

A description of genes of Corynebacterium pseudotuberculosis useful in diagnostics and vaccine applications

Corynebacterium pseudotuberculosis, a Gram-positive intracellular pathogen, is the etiological agent of caseous lymphadenitis or CLA. This bacterium infects goats and sheep and causes great economic losses worldwide annually, mainly for goat producers. Despite its importance, CLA is still poorly characterized. However, with advances in the genomic field, many C. pseudotuberculosis genes have already been characterized, mainly those related to virulence such as phospholipase D. Here, we examined the use of the several available genes of C. pseudotuberculosis and reviewed their applications in vaccine construction, more efficient diagnostics for CLA, and control of this disease, among other applications.

Diagnóstico de pseudotuberculosis en ovinos patagónicos / Diagnosis of caseous lymphadenitis in sheep from Patagonia

La linfadenitis caseosa (LAC) es una enfermedad bacteriana supurativa crónica que afecta a ovinos. El agente etiológico es Corynebacterium pseudotuberculosis. El diagnóstico diferencial con otras afecciones que presentan manifestaciones clínicas similares sólo puede hacerse sobre la base del aislamiento y la identificación del agente etiológico. El objetivo de este trabajo fue caracterizar metabólica y genéticamente al agente causal de abscesos granulomatosos observados en ovinos en la región patagónica. En las muestras, se observó un contenido caseoso rodeado de una membrana fibrosa, y en el examen histopatológico, un centro de necrosis caseosa rodeado por células epitelioides, linfocitos y polinucleares. Mediante estudios microscópicos, bacteriológicos y moleculares fue confirmada la infección causada por C. pseudotuberculosis biovar ovis.

Caseous lymphadenitis (CLA) is a chronic bacterial, infectious and contagious disease caused by Corynebacterium pseudotuberculosis. It affects sheep and results in abscesses of the lymph nodes in subcutaneous tissue, as well as in internal organs such as lungs, liver and kidneys. Differential diagnosis of the disease is based on the isolation and biochemical identification of the etiological agent. The purpose of this study was to characterize the bacteria isolated from typical CLA lesions in sheep from Patagonia, Argentina, at metabolic and genetic levels. Macroscopic observations show a fibrous membrane containing caseous necrotic tissue. Histopathological analysis shows an eosinophilic necrotic area surrounded by epitheloid cells and polymorphonuclear infiltration. Other analyses performed such as microscopic observations, in vitro culture, biochemical tests and 16s rDNA sequencing confirmed diagnosis of caseous lymphadenitis due to C. pseudotuberculosis.