First isolation and whole-genome sequencing of Trueperella abortisuis from a goat in Canada.

Objective: The present study reports the first isolation and whole-genome sequencing of a Trueperella abortisuis bacterium from a goat. Animals and sample: The T. abortisuis was isolated from the uterus of a goat following an abortion. Procedure: The T. abortisuis was identified by pure culture phenotype and MALDI-TOF analysis and further characterized by whole-genome sequencing. Results: This isolate was reliably identified as T. abortisuis and showed similar properties to type strain T. abortisuis DSM 19515T, which was recovered from a sow following an abortion. The assembled genome of this isolate was 2 564 866 bp long with a GC content of 63.9%. A total of 30 virulence-related genes were determined, suggesting the pathogenic potential of this organism. Conclusion and clinical relevance: This study details the first isolation of T. abortisuis from goats. The genotypic findings of this isolate will serve as a baseline description for any similar future studies.

Premier isolement et séquençage du génome entier de Trueperella abortisuis provenant d'une chèvre au Canada. Objectif: La présente étude rapporte le premier isolement et séquençage du génome entier d'un isolat de Trueperella abortisuis provenant d'une chèvre. Animaux et échantillon: Le T. abortisuis a été isolé de l'utérus d'une chèvre à la suite d'un avortement. Procédure: Le T. abortisuis a été identifié par un phénotype de culture pure et analyse par MALDI-TOF, puis caractérisé par séquençage du génome entier. Résultats: Cet isolat a été identifié de manière fiable comme étant T. abortisuis et a montré des propriétés similaires à la souche type T. abortisuis DSM 19515T, qui a été récupérée chez une truie après un avortement. Le génome assemblé de cet isolat mesurait 2 564 866 pb avec une teneur en GC de 63,9 %. Au total, 30 gènes liés à la virulence ont été déterminés, suggérant le potentiel pathogène de cet organisme. Conclusion et pertinence clinique: Cette étude détaille le premier isolement de T. abortisuis chez la chèvre. Les résultats génotypiques de cet isolat serviront de description de base pour toute étude future similaire.(Traduit par Dr Serge Messier).

[A New Case of Fournier's Gangrene Caused by Actinotignum schaalii]. / Actinotignum schaalii'nin Etken Oldugu Yeni Bir Fournier Gangreni Olgusu.

Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO2-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65-year-old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram-positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) VITEK® MS (bioMérieux, France) microbial identification system. VITEK®2 ID ANC (bioMérieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.

Complete genome sequence of Schaalia odontolytica isolated from subgingival biofilm.

OBJECTIVE: Recent advancements in genome-based taxonomic classification propose the reclassification of certain Actinomyces species into new genera, including Schaalia. Schaalia odontolytica, the type species within this genus, is frequently found in the human oral cavity and has been associated with actinomycotic lesions. Currently, only two complete genomes of S. odontolytica strains have been reported. Recognizing the limited research on subspecies-level variation of S. odontolytica, we conducted genome sequencing of strain KHUD_008, isolated from a Korean periodontitis patient's subgingival biofilm. Additionally, we performed a comparative genome analysis using previously sequenced genomes of strain XH001 and strain FDAARGOS_732, both derived from the human oral cavity. DATA DESCRIPTION: Pacific Biosciences Sequel II sequencing generated 15,904 and 76,557 raw sequencing sub-reads, which were integrated to assemble the de novo genome using the Microbial Genome Analysis pipeline in the Single-Molecule Real-Time Analysis. The genome assembly completeness, assessed by Benchmarking Universal Single-Copy Orthologs, reached 99.2%. The genome is 2,389,595 bp with a GC content of 66.37%, and contains 2,002 protein-coding genes, 9 rRNAs, and 48 tRNA. Comparative analysis with two previously sequenced strains revealed many strain-specific genes in KHUD_008, primarily related to envelope biogenesis and replication/recombination/repair processes.

Case report: A rare case of skin abscess caused by coinfection of Actinobaculum schaalii and Actinomyces turicensis.

Skin abscess is one of the most common infections of the skin and soft tissues. However, anaerobic bacteria are infrequently identified as the causative agents of this particular form of abscess. In this case, a 34-year-old pregnant woman was diagnosed with a skin abscess with the use of ultrasonography. The microbiological analysis results of the purulent fluid revealed the coinfection of Actinobaculum schaalii and Actinomyces turicensis. The patient was first treated empirically with 3 days of cefathiamidine, which resulted in no symptom improvement. Subsequently, a surgical procedure involving incision and draining was performed, with the administration of ceftriaxone. After 7 days of antibiotic intervention, the patient exhibited a satisfactory recovery. Clinicians need to be aware of other types of infections that might be attributed to Actinobaculum schaalii and Actinomyces turicensis, in addition to urinary tract infections.

Whole genome-based antimicrobial resistance, virulence, and phylogenetic characteristics of Trueperella pyogenes clinical isolates from humans and animals.

Trueperella pyogenes is an opportunistic zoonotic bacterial pathogen, whose antimicrobial resistance, virulence, and genetic relatedness between strains from animals and humans are barely studied. These characteristics were therefore analyzed for clinical T. pyogenes strains from 31 animals of 11 different species and 8 humans determining their complete circular genome sequence and antimicrobial susceptibility. The MICs of 19 antimicrobials including 3 antiseptics correlated to the resistance genes identified in silico within the genomes revealing a predominance of resistance to streptomycin (aadA9), sulfamethoxazole (sul1), and tetracycline (tet(33), tet(W/N/W)) among strains from humans and cattle. Additional resistance genes (erm(X), erm(56), cmx, drfA1, aadA1, aph(3'')-Ib (strA), aph(6)-Id (strB), aac(3)-IVa, aph(4)-Ia) were found only sporadically. The resistance genes were localized on genetic elements integrated into the chromosome. A cgMLST-based phylogenetic analysis revealed two major clusters each containing genetically diverse strains. The human strains showed the closest relatedness to strains from cattle. Virulence genes coding for fimbriae (fimA, fimC), neuroamidase (nanP, nanH), pyolysin (plo), and collagen binding protein (cbpA) were identified in strains from different hosts, but no correlation was observed between virulence factors and strain origin. The existence of resistance genes typically found in Gram-negative bacteria within the Gram-positive T. pyogenes indicates a wider capacity to adapt to antimicrobial selective pressure. Moreover, the presence of similar antimicrobial resistance profiles found in cattle and human strains as well as their closest relatedness suggests common zoonotic features and cattle as the potential source for human infections.

Multiphasic investigations imply transfer of orange-/red-pigmented strains of the bean pathogen Curtobacterium flaccumfaciens pv. flaccumfaciens to a new species as C. aurantiacum sp. nov., elevation of the poinsettia pathogen C. flaccumfaciens pv. poinsettiae to the species level as C. Poinsettiae sp. nov., and synonymy of C. albidum with C. citreum.

Curtobacterium flaccumfaciens (Microbacteriaceae), a plant-pathogenic coryneform species includes five pathovars with valid names and a number of proposed - but unvalidated - new members. In this study, phenotypic features and DNA similarity indexes were investigated among all C. flaccumfaciens members. Results showed that the C. flaccumfaciens pv. poinsettiae strains causing bacterial canker of Euphorbia pulcherrima in the USA as well as the orange-/red-pigmented strains of C. flaccumfaciens pv. flaccumfaciens pathogenic on dry beans in Iran are too distinct from each other and from the type strain of the species to be considered members of C. flaccumfaciens. Hence, the latter two groups were elevated at the species level as C. poinsettiae sp. nov. (ATCC 9682T = CFBP 2403T = ICMP 2566T = LMG 3715T = NCPPB 854T as type strain), and C. aurantiacum sp. nov. (50RT = CFBP 8819T = ICMP 22071T as type strain). Within the emended species C. flaccumfaciens comb. nov., yellow-pigmented strains causing bacterial wilt of dry beans and those causing bacterial canker of Euphorbia pulcherrima in Europe were retained as C. flaccumfaciens pv. flaccumfaciens and C. flaccumfaciens pv. poinsettiae, respectively; while taxonomic position of the sugar beet pathogen C. flaccumfaciens pv. beticola ATCC BAA144PT was confirmed. The newly described onion pathogen C. allii was also reclassified as C. flaccumfaciens pv. allii with the pathotype strain LMG 32517PT. Furthermore, C. flaccumfaciens pv. basellae causing bacterial leaf spot of malabar spinach (Basella rubra) was transferred to C. citreum pv. basellae with ATCC BAA143PT as pathotype.

Comparison of CRISPR typing and conventional molecular methods for distinguishing Laribacter hongkongensis isolates from fish, frogs and humans.

High-resolution and efficient typing for Laribacter hongkongensis (L. hongkongensis) is essential for epidemiological investigation of such emerging foodborne pathogens. Clustered regularly interspaced short palindromic repeats (CRISPR) typing is an innovative molecular method that shows great promise for L. hongkongensis typing. Here, we explored the CRISPR typing method by combining CRISPR1 and CRISPR2 loci to characterize a collection of 109 L. hongkongensis isolates from humans and animals and compared it to current molecular methods such as pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The results showed that all three methods have high discriminatory power (diversity index was 0.9902 for PFGE, 0.9663 for CRISPR and 0.9562 for MLST); strong congruence was observed between them (Rand index was 0.969 between CRISPR and PFGE, 0.953 between CRISPR and MLST, 0.958 between PFGE and MLST). CRISPR typing could well distinguish the isolates in the same STs or PFGE profiles, and the genetic information contained by the CRISPR array is useful for deep phylogenetic typing. We demonstrate that rapid CRISPR typing is a practical genetic fingerprinting tool with high resolution, comparable ease of use and lower cost, ability to track the source of various groups of L. hongkongensis strains and indication of genetic characteristics.

Empyema caused by Actinomyces odontolyticus: A case report.

RATIONALE: Actinomyces odontolyticus causes a rare, chronic granulomatous infection that is frequently associated with immunocompromised states. A odontolyticus can cause infection in multiple organs, but empyema is rare. PATIENT CONCERNS: We report a case of empyema caused by A odontolyticus. The patient was a 64-year-old man. He was admitted to the hospital with a 5-day history of fever and dyspnea. He had caries and sequelae of cerebral apoplexy. DIAGNOSES: Metagenome next generation sequencing of pleural effusion was positive for A odontolyticus. Pathogen was identified by biphasic culture of pleural effusion fluid. INTERVENTIONS: According to the drug sensitivity test, linezolid 0.6 g twice daily and clindamycin 0.6 g 3 times a day were administered intravenously. Thoracic drainage was initially performed, but the drainage was not sufficient. Medical thoracoscopy was performed to fully drain the pleural effusion. OUTCOMES: After anti-infection and medical thoracoscopic therapy, the symptoms of this patient improved. LESSONS: Microbial metagenome sequencing can find pathogens that are difficult to culture by traditional methods. Adequate drainage was the key to the treatment of empyema. Medical thoracoscopy was recommended to remove the pleural effusion and spoilage when thoracic drainage is difficult. The common clinical features of A odontolyticus include a mass or swelling, abdominal disease, dental disease, and subcutaneous abscesses. Microbial metagenome sequencing can find pathogens that are difficult to culture by traditional methods. Adequate drainage was the key to the treatment of empyema. Medical thoracoscopy was recommended to remove the pleural effusion and spoilage when thoracic drainage is difficult.

Unraveling the mystery: a Mendelian randomized exploration of gut microbiota and different types of obesity.

Background: Numerous studies have demonstrated the influence of gut microbiota on the development of obesity. In this study, we utilized Mendelian randomization (MR) analysis to investigate the gut microbiota characteristics among different types of obese patients, aiming to elucidate the underlying mechanisms and provide novel insights for obesity treatment. Methods: Two-sample multivariable Mendelian randomization (MR) analysis was employed to assess causal relationships between gut microbiota and various obesity subtypes. Gut microbiota data were obtained from the international consortium MiBioGen, and data on obese individuals were sourced from the Finnish National Biobank FinnGen. Eligible single-nucleotide polymorphisms (SNPs) were selected as instrumental variables. Various analytical methods, including inverse variance weighted (IVW), MR-Egger regression, weighted median, MR-RAPS, and Lasso regression, were applied. Sensitivity analyses for quality control included MR-Egger intercept tests, Cochran's Q tests, and leave-one-out analyses and others. Results: Mendelian randomization studies revealed distinct gut microbiota profiles among European populations with different obesity subtypes. Following multivariable MR analysis, we found that Ruminococcaceae UCG010 [Odds Ratio (OR): 0.842, 95% confidence interval (CI): 0.766-0.926, Adjusted P value: 0.028] independently reduced the risk of obesity induced by excessive calorie intake, while Butyricimonas [OR: 4.252, 95% CI: 2.177-8.307, Adjusted P value: 0.002] independently increased the risk of medication-induced obesity. For localized adiposity, Pasteurellaceae [OR: 0.213, 95% CI: 0.115-0.395, Adjusted P value: <0.001] acted as a protective factor. In the case of extreme obesity with alveolar hypoventilation, lactobacillus [OR: 0.724, 95% CI: 0.609-0.860, Adjusted P value: 0.035] reduced the risk of its occurrence. Additionally, six gut microbiota may have potential roles in the onset of different types of obesity. Specifically, the Ruminococcus torques group may increase the risk of its occurrence. Desulfovibrio and Catenabacterium may serve as protective factors in the onset of Drug-induced obesity. Oxalobacteraceae, Actinomycetaceae, and Ruminiclostridium 9, on the other hand, could potentially increase the risk of Drug-induced obesity. No evidence of heterogeneity or horizontal pleiotropy among SNPs was found in the above studies (all P values for Q test and MR-Egger intercept > 0.05). Conclusion: Gut microbiota abundance is causally related to obesity, with distinct gut microbiota profiles observed among different obesity subtypes. Four bacterial species, including Ruminococcaceae UCG010, Butyricimonas, Pasteurellaceae and lactobacillus independently influence the development of various types of obesity. Probiotic and prebiotic supplementation may represent a novel approach in future obesity management.

Antimicrobial efficiency of bromhexine hydrochloride against endometritis-causing Escherichia coli and Trueperella pyogenes in bovines.

In this study, the main agents associated with endometritis in cows in the state of Santa Catarina, Brazil, were identified and the resistance profile and virulence mechanisms of the bacterial isolates were evaluated. Isolates of Escherichia coli and Trueperella pyogenes were tested for their biofilm forming ability and the antimicrobial action of bromhexine hydrochloride in combination with other antimicrobials. A total of 37 uterine lavage samples were collected from cows with endometritis. Of the 55 bacteria isolated, 25.4% were identified as T. pyogenes and 16.3% as E. coli. The bacterial isolates showed greater resistance to sulfamethoxazole + trimethoprim (58.2%) and tetracycline (56.3%). Among the species, E. coli showed the highest resistance rates, with 100% of isolates showing resistance to amoxicillin, streptomycin, and gentamicin. The results of the minimum inhibitory concentration for the T. pyogenes isolates showed that 91.6% of the isolates were resistant to enrofloxacin and tetracycline, and 75% were resistant to ceftiofur and sulfamethoxazole + trimethoprim. All E. coli and T. pyogenes isolates showed biofilm forming ability. The plo, fimA, and nanH genes were identified in 100% of T. pyogenes isolates. In parallel, 100% of E. coli isolates had the fimH gene, and 11.1% had the csgD gene. Bromhexine hydrochloride showed antimicrobial activity against 100% of E. coli isolates and 66.6% of T. pyogenes isolates. Furthermore, when associated with antimicrobials, bromhexine hydrochloride has a synergistic and additive effect, proving to be an option in the treatment of endometritis in cows and an alternative for reducing the use of antimicrobials.

Herida abscesificada debido a Trueperella bernardiae / Abscessed wound resulting from Trueperella Bernardiae

Trueperella bernardiae es un microorganismo grampositivo facultativo anaerobio que forma parte de la microbiota normal de la piel y de la orofaringe, que recientemente ha sido reasignado l género Trueperella. Este patógeno ha sido descrito en muy pocos casos como causante de infección en los seres humanos, debido a su aspecto corineforme y su presencia en cultivos mixtos, y a las dificultades diagnósticas

Use of MALDI-TOF MS in diagnostic microbiology for identification of species that conventional methods usually fail to identify

(MALDI-TOF MS) has been used in clinical diagnostic laboratories for the identification of microorganisms. It has a relevant advantage compared to other methods in terms of speed to provide results, being an alternative for addressing restrictions in clinical diagnosis as it may replace or complement existing identification techniques. This is especially important because some rare microorganisms would be identified only by higher cost techniques which are not widely available, such as genetic sequencing. Thus, the present paper reports two cases in which uncommon microorganisms were identified effectively and quickly. (AU)

Trueperella pyogenes como causa de aborto em uma vaca - relato de caso / Trueperella pyogenes as an abortion cause in a cow - case report

Trueperella pyogenes é uma bactéria oportunista que causa mastite, metrite e abortos esporádicos em bovinos. Este trabalho relata um caso incomum de abort em uma vaca por Trueperella pyogenes. Um feto bovino, fêmea, mestiço Brahman, com oito meses de gestação, foi encaminhado para exame anatomopatológico e exames complementares. Na necropsia, evidenciou-se grande quantidade de líquido serossanguinolento e moderada quantidade de fibrina recobrindo a pleura visceral e o saco pericárdico. Os pulmões estavam difusamente avermelhados e consolidados, com áreas firmes esbranquiçadas ao corte de não mais de 1cm. No exame histopatológico, observou-se pneumonia necrossupurativa, pleurite fibrinopurulenta e placentite purulenta. No exame microbiológico, isolou-se T. pyogenes nas amostras de fígado, pulmões, conteúdo abomasal do feto e placenta. O feto foi negativo na PCR para Neospora caninum, Toxoplasma gondii e vírus da diarreia viral bovina (BVDV). Trueperella pyogenes geralmente causa broncopneumonia supurativa com formação de abscessos, porém, no presente feto abortado, observaram-se lesões macro e microscópicas comumente descritas em casos de aborto por Brucella abortus. Este estudo constata, então, a importância dessa bactéria como causa de aborto em bovinos, com lesões semelhantes à brucelose, destacando sua relevância dentro das causas de aborto em bovinos e o potencial zoonótico pouco explorado.(AU)

Trueperella pyogenes is an opportunistic bacterium associated with mastitis, metritis and occasional abortion in bovines. Here we report an uncommon case of abortion by T. pyogenes in a cow. An aborted female Brahman bovine fetus, at 8 months of gestational age was submitted for anatomopathological examination and complementary diagnostic tests. Macroscopic findings at necropsy included large amounts of free serum-blood fluid and moderate fibrin deposition covering both the visceral pleura and pericardial sack. The lungs were diffusely reddened and markedly consolidated, showing widespread smaller than 1cm, hard, white nodules. Necrosuppurative pneumonia, fibrinopurulent pleuritis, and purulent placentitis were the main histopathologic alterations observed. Trueperella pyogenes was isolated from liver, lungs, abomasa contents and placental samples. All tissue samples were PCR-negative for Neospora caninum, Toxoplasma gondii and bovine viral diarrhea virus (BVDV). Although T. pyogenes is often involved in suppurative bronchopneumonia and abscesses formation, macro and microscopic lesions in the present report were compatible with those commonly attributed to Brucella abortus fetal infections. Trueperella pyogenes is an important bovine pathogen with a neglected zoonotic potential being responsible for infections that can mimic other diseases' typical presentations.(AU)

Absceso hepático por Arcanobacterium haemolyticum

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Preservação de fungos e actinomicetos de interesse médico em água destilada / Preservation of fungi and actinomycetes of medical importance in distilled water

Several methods have been used for the preservation of fungi, all of them presenting advantages and disadvantages. The choice of the methods depends upon the laboratory availabilities, time of preservation, genetic stability of the cultures and other factors. In this work the results obtained through the utilization of Castellani's method (preservation in distilled water) for the maintenance of 174 strains belonging to the "Micoteca do Instituto de Medicina Tropical de São Paulo" are presented. These strains were analyzed after 6, 12, 18 and 24 months, with regard to the percentage of viability taking into consideration the rates of growth and contamination. The smallest percentage of viability occurred in the group of the actinomycetes (50 to 100) and the largest one in the group of the yeasts (near 100). According to other authors, the Castellani's method, besides being simple and economically feasible for small size laboratories, yields good results.

Infecciones por Arcanobacterium haemolyticum: un patógeno emergente / Infections by Arcanobacterium haemolyticum: an emerging pathogen

Arcanobacterium haemolyticum es un bacilo grampositivo perteneciente, hasta hace poco, al género corynebacterium, y clasificado recientemente en un nuevo género, con una sola especie. Su principal reservorio es el hombre. Ha sido aislado de la piel y faringe de individuos sanos, pero también como causa de infección, principalmente faringitis, en niños, y úlceras cutáneas crónicas, en diabéticos. Con menos frecuencia puede dar lugar a osteomielitis, meningitis, abscesos, neumonía, endocarditis y sepsis. El diagnóstico se ve dificultado por su doble cualidad de comensal y patógeno. Para el tratamiento de estas infecciones no existen protocolos establecidos, aunque la mayoría de las cepas aisladas son sensibles a penicilina, eritromicina, clindamicina y tetraciclina. Para el tratamiento de las infecciones profundas, se recomienda penicilina a dosis altas con o sin aminoglucósidos (AU)

Arcanobacterium haemolyticum is a grampositive rod wich belonged, untill a short time ago, to Corynebacterium genus, and recently classified in a new genus, with only one specie. Human is the main reservoir. It has been isolated from the skin and pharinx of healthy individuals, but also it is cause of infection, specially pharingitis, in children, and chronic cutaneous ulcus, in diabetic patients. Less frequently, it is cause of osteomyelitis, meningitis, pneumonia, abscess, endocarditis and sepsis. Diagnosis is difficult because its double quality: comensal and pathogen. There are not established guidelines for the treatment of these infections, although most of isolated strains are susceptibles to penicillin, erythromicin, clindamycin and tetracycline. High doses of penicillin, with or without gentamicin, it is recommended for the treatment of deep infections (AU)