Clonal multidrug-resistant Corynebacterium striatum within a nosocomial environment, Rio de Janeiro, Brazil.

Corynebacterium striatum is a potentially pathogenic microorganism with the ability to produce outbreaks of nosocomial infections. Here, we document a nosocomial outbreak caused by multidrug-resistant (MDR) C. striatum in Rio de Janeiro, Brazil. C. striatum identification was confirmed by 16S rRNA and rpoB gene sequencing. Fifteen C. striatum strains were isolated from adults (half of whom were 50 years of age and older). C. striatum was mostly isolated in pure culture from tracheal aspirates of patients undergoing endotracheal intubation procedures. The analysis by pulsed-field gel electrophoresis (PFGE) indicated the presence of four PFGE profiles, including two related clones of MDR strains (PFGE I and II). The data demonstrated the predominance of PFGE type I, comprising 11 MDR isolates that were mostly isolated from intensive care units and surgical wards. A potential causal link between death and MDR C. striatum (PFGE types I and II) infection was observed in five cases.

Nocardiosis: an overview and additional report of 28 cases in cattle and dogs.

Phenotypic characteristics, antimicrobial susceptibility profile, and clinical-epidemiological features of 28 Nocardia strains isolated from 19 cases of bovine mastitis, eight cutaneous-subcutaneous lesions and one case of pneumonia in dogs were evaluated. Microbiological, biochemical, cytological and scanning electron microscopy methods were used in diagnosis. Nocardia asteroides type IV, Nocardia otitidiscaviarum,Nocardia nova (type III) and Nocardia farcinica (type V) were isolated from bovine milk, bronchial lavage and/or cutaneous-subcutaneous abscesses in dogs. Nocardial bovine mastitis was diagnosed predominantly in clinical cases, in dairy herds with poor environmental hygienic conditions between milking and inappropriate intramammary therapy. Canine nocardiosis was observed commonly in animals co-infected with distemper virus. Sulphamethoxazole-trimethoprim (92.8%), amikacin (92.8%) and ceftiofur (92.8%) were the most effective drugs in 28 isolates. Multiple drug resistance to three or more and five or more antimicrobials was observed in ten (35.7%) and three (10.7%) strains, respectively, predominantly with use of cloxaxillin, cefoperazone and ampicillin. The species (type) classification, clinical-epidemiological characteristics, diagnosis, multiple-drug resistance and public health considerations in Nocardia strains isolated from cattle and dogs in Brazil are discussed, with special reference to report of bovine mastitis by N. otitidiscaviarum by first time in Brazil and the similarity between Nocardia species isolated from human and animal origin.

Molecular identification of nocardia isolates from clinical samples and an overview of human nocardiosis in Brazil.

BACKGROUND: Nocardia sp. causes a variety of clinical presentations. The incidence of nocardiosis varies geographically according to several factors, such as the prevalence of HIV infections, transplants, neoplastic and rheumatic diseases, as well as climate, socio-economic conditions and laboratory procedures for Nocardia detection and identification. In Brazil the paucity of clinical reports of Nocardia infections suggests that this genus may be underestimated as a cause of human diseases and/or either neglected or misidentified in laboratory specimens. Accurate identification of Nocardia species has become increasingly important for clinical and epidemiological investigations. In this study, seven clinical Nocardia isolates were identified by multilocus sequence analysis (MLSA) and their antimicrobial susceptibility was also determined. Most Nocardia isolates were associated to pulmonary disease. METHODOLOGY/PRINCIPAL FINDINGS: The majority of Brazilian human isolates in cases reported in literature were identified as Nocardia sp. Molecular characterization was used for species identification of Nocardia nova, Nocardia cyriacigeorgica, Nocardia asiatica and Nocardia exalbida/gamkensis. Data indicated that molecular analysis provided a different Nocardia speciation than the initial biochemical identification for most Brazilian isolates. All Nocardia isolates showed susceptibility to trimethoprim-sulfamethoxazole, the antimicrobial of choice in the treatment nocardiosis. N. nova isolated from different clinical specimens from one patient showed identical antimicrobial susceptibility patterns and two distinct clones. CONCLUSIONS/SIGNIFICANCE: Although Brazil is the world's fifth-largest country in terms of land mass and population, pulmonary, extrapulmonary and systemic forms of nocardiosis were reported in only 6 of the 26 Brazilian states from 1970 to 2013. A least 33.8% of these 46 cases of nocardiosis proved fatal. Interestingly, coinfection by two clones may occur in patients presenting nocardiosis. Nocardia infection may be more common throughout the Brazilian territory and in other developing tropical countries than is currently recognized and MLSA should be used more extensively as an effective method for Nocardia identification.

Clonal multidrug-resistant Corynebacterium striatum within a nosocomial environment, Rio de Janeiro, Brazil

Corynebacterium striatum is a potentially pathogenic microorganism with the ability to produce outbreaks of nosocomial infections. Here, we document a nosocomial outbreak caused by multidrug-resistant (MDR) C. striatum in Rio de Janeiro, Brazil. C. striatum identification was confirmed by 16S rRNA and rpoB gene sequencing. Fifteen C. striatum strains were isolated from adults (half of whom were 50 years of age and older). C. striatum was mostly isolated in pure culture from tracheal aspirates of patients undergoing endotracheal intubation procedures. The analysis by pulsed-field gel electrophoresis (PFGE) indicated the presence of four PFGE profiles, including two related clones of MDR strains (PFGE I and II). The data demonstrated the predominance of PFGE type I, comprising 11 MDR isolates that were mostly isolated from intensive care units and surgical wards. A potential causal link between death and MDR C. striatum (PFGE types I and II) infection was observed in five cases.

Pyogenic liver abscess due to Rhodococcus equi in an immunocompetent host.

A case of pyogenic liver abscess (PLA) due to Rhodococcus equi in an immunocompetent individual was successfully treated by combining surgery and antibiotics. The R. equi-targeted antimicrobial agents erythromycin and rifampin were used only after surgical resection of the lesion and identification of the infective organism.

Nocardiosis: an overview and additional report of 28 cases in cattle and dogs / Nocardiose: visão geral e relato de 28 casos em vacas e cães

Phenotypic characteristics, antimicrobial susceptibility profile, and clinical-epidemiological features of 28 Nocardia strains isolated from 19 cases of bovine mastitis, eight cutaneous-subcutaneous lesions and one case of pneumonia in dogs were evaluated. Microbiological, biochemical, cytological and scanning electron microscopy methods were used in diagnosis. Nocardia asteroides type IV, Nocardia otitidiscaviarum,Nocardia nova (type III) and Nocardia farcinica (type V) were isolated from bovine milk, bronchial lavage and/or cutaneous-subcutaneous abscesses in dogs. Nocardial bovine mastitis was diagnosed predominantly in clinical cases, in dairy herds with poor environmental hygienic conditions between milking and inappropriate intramammary therapy. Canine nocardiosis was observed commonly in animals co-infected with distemper virus. Sulphamethoxazole-trimethoprim (92.8 percent), amikacin (92.8 percent) and ceftiofur (92.8 percent) were the most effective drugs in 28 isolates. Multiple drug resistance to three or more and five or more antimicrobials was observed in ten (35.7 percent) and three (10.7 percent) strains, respectively, predominantly with use of cloxaxillin, cefoperazone and ampicillin. The species (type) classification, clinical-epidemiological characteristics, diagnosis, multiple-drug resistance and public health considerations in Nocardia strains isolated from cattle and dogs in Brazil are discussed, with special reference to report of bovine mastitis by N. otitidiscaviarum by first time in Brazil and the similarity between Nocardia species isolated from human and animal origin.

A caracterização fenotípica, perfil de sensibilidade aos antimicrobianos e aspectos clínico-epidemiológicos foram avaliados em 28 linhagens de Nocardia isoladas de 19 casos de mastite, oito lesões tegumentares e um caso de pneumonia em cão. Foram utilizados no diagnóstico métodos microbiológicos, bioquímicos, citológicos e microscopia eletrônica de varredura. Nocardia asteroides tipo IV, N. otitidiscaviarum,N. nova (tipo III) e N. farcinica (tipo V) foram isoladas do leite de vacas com mastite, de material de lavado transtraqueal e de lesões cutâneas de cães. Nocardiose mamária bovina foi diagnosticada predominantemente sob a forma clínica, em propriedades com precárias condições de higiene na pré e pós-ordenha, e inadequado procedimento de terapia intramamária. Nocardiose canina foi diagnosticada comumente em animais co-infectados com o vírus da cinomose. Sulfametoxazole/trimetoprim (92,8 por cento), amicacina (92,8 por cento) e ceftiofur (92,8 por cento) foram os antimicrobianos mais efetivos frente às linhagens de Nocardia. Resistência múltipla a três ou mais e cinco ou mais antimicrobianos foram observadas, respectivamente, em dez (35,7 por cento) e três (10,7 por cento) linhagens, notadamente frente à cloxacilina, cefoperazona e ampicilina. A caracterização de espécies (tipo), aspectos clínico-epidemiológicos, diagnóstico, resistência múltipla aos antimicrobianos e reflexos em saúde pública de linhagens de Nocardia isoladas de bovinos e cães no Brasil foram discutidos. Foi destacada a similaridade entre as espécies de Nocardia isoladas de animais e do homem, e a primeira descrição no Brasil de N. otitidiscaviarum na etiologia da mastite bovina.

Nondiphtherial Corynebacterium species isolated from clinical specimens of patients in a university hospital, Rio de Janeiro, Brazil

Over a five-year period, 163 strains of Corynebacterium sp. were recovered from different clinical specimens of patients from a Brazilian University hospital. Genitourinary tract and intravenous sites specimens were the most frequent sources of corynebacteria (46.62 percent). Corynebacterium amycolatum (29.55 percent), Corynebacterium minutissimum (20.45 percent) and Corynebacterium pseudodiphtheriticum (13.63 percent) were the predominant species found in genitourinary tract. C. minutissimum (24.14 percent) and Corynebacterium propinquum (17.24 percent) in surgical and/or other skin wounds and abscesses; Corynebacterium xerosis (25 percent), C. amycolatum (21.87 percent) and C. pseudodiphtheriticum (18.75 percent) in intravenous sites; C. pseudodiphtheriticum (33.33 percent) and C. propinquum (33.33 percent) in lower respiratory tract. Microorganisms were all susceptible to vancomycin and most of the species was predominantly resistant to beta-lactams. Antimicrobial susceptibility patterns of corynebacteria were not predictable. Multiple antibiotic resistance observed in C. jeikeium was also found among C. xerosis, C. minutissimum, C. afermentans, C. propinquum, C. amycolatum and C. pseudodiphtheriticum strains. Data suggest awareness of clinicians and microbiologists to nosocomial infections especially due to antimicrobial multiresistant strains of Corynebacterium sp.

Diphetria in a vaccinated adult in Rio de Janeiro, Brazil

In 1999, a case of diphtheria in a 32-year-old woman was reported. The patient developed a sore throat immediately after participating of a five-day meeting with European workers in Rio de Janeiro. Her history included complete pediatric immunization (DTP) and three doses of adult formulation tetanus and diphtheria toxoid (dT) two years earlier. Clinical diagnosis of diphtheria was not made until microbiologic examination of specimens confirmed toxigenicity of Corynebacterium diphtheriae var. gravis, a biotype currently found circulating within Europe where diphtheria remains epidemic. This case reinforces the potential susceptibility of Brazilian adults to epidemic diphtheria in the vaccine era.

Corinebacterioses humanas em países emergentes - Corynebacterium pseudodiphtheriticum - patógeno relevante / Human corynebacteriosis in emerging countries - Corynebacterium pseudodiphtheriticum - pathogen relevant

Diversas espécies pertencentes ao gênero Corynebacterium spp. têm sido frequentemente associadas com quadros graves de infecção (sepsis, endocardites, infecções cirúrgicas, próteses e infecções relacionadas ao cateter venoso, entre outras), particularmente, no ambiente nosocomial. Quando essas infecções estão relacionadas a espécies multirresistentes, estas são de difícil ou impossível tratamento. Escassos são os trabalhos realizados no Brasil que investigam a presença de amostras de corinebactérias relacionadas com processos infecciosos em pacientes atendidos em instituições públicas e privadas. No presente estudo, foram isoladas 163 amostras de corinebactérias, a partir de espécimes clínicos oriundos de pacientes atendidos no HUPE-UERJ. A maioria das amostras foi isolada do trato geniturinário e sítios intravenosos (46,6%), sendo Corynebacterium amycolatum (29,55%)> Corynebacterium minutissimum (20,45%)> Corynebacterium pseudodiphtheriticum (13,63%) as espécies mais frequentemente encontradas. Corynebacterium minutissimum (24,14%)> Corynebacterium propinquum (17,24%) em cirurgias e/ou pele feridas e abscessos; Corynebacterium xerosis (25%)> Corynebacterium amycolatum (21,87%)> Corynebacterium pseudodiphtheriticum (18,75%) nos sítios intravenosos; Corynebacterium pseudodiphtheriticum (33,33%) e Corynebacterium propinquum (33,33 %) no trato respiratório inferior. Em relação aos testes de sensibilidade aos antimicrobianos testados rotineiramente, observamos que todos os microrganismos apresentaram sensibilidade à vancomicina e teicoplanina, enquanto a maioria das espécies foi predominantemente resistente aos b-lactâmicos. No período de 1993 a 2006, 113 amostras de C. pseudodiphtheriticum foram isoladas em ambiente hospitalar, principalmente em urina, trato respiratório baixo, sítios intravenosos e sangue, além de líquido peritoneal e abscesso, entre outros...

Various species belonging to the genus Corynebacterium spp. have been frequently associated with serious infection (sepsis, endocarditis, surgical infections, prostheses and infections related to venous catheter, among others), paticularly in nosocomial environment. Such infections are frequently difficult to treat when caused by multiresistant strains. Reports dealing with the descreption of infections process caused by corynebacteria in both public and private institutions in Brazil are scarce. In the present study, 163 corynebacterium strains were isolated from clinical specimens from patients in HUPE-UERJ. Most of the strains were isolated from genitourinary tract and intravenous sites (46,62%). Corynebacterium amycolatum (29,55%)> Corynebacterium minutissimum (20,45%)> Corynebacterium pseudodiphtheriticum (13,63%) the most often isolated species in genitourinary tract. Corynebacterium minutissimum (24,14%)> Corynebacterium propinquum (17,24%), in surgery, and/or skin and abscesses; Corynebacterium xerosis (25%)> Corynebacterium amycolatum (21,87%)> Corynebacterium pseudodiphtheriticum (18,75%) were isolated from intravenous sites. Corynebacterium pseudodiphtheriticum (33,33%) and Corynebacterium propinquum (33,33%) were the most frequently species from lower respiratory tract. In relation to the sensibility to antibiotics routinely used clinically, it was observed that all microorganisms showed sensitivity to vancomycin and teicoplanin, while the majority of strains were predominantly resistant to b-lactam. From 1993 to 2006, 113 C. pseudodiphtheriticum strians were isolated predominantly from nosocomial environment from urine, lower respiratory tract, blood and intravenous sites, peritoneal fluid and abscess. The predominantly underlying conditions were renal failure, hemodialysis and/or transplant; and HIV infection...