Bacteremia and sepsis by Arcanobacterium haemolyticum in a young immunocompetent patient / Bacteriemia y sepsis por Arcanobacterium haemolyticum en un paciente joven inmunocompetente

Abstract We report the case of a twenty-year-old immunocompetent male patient presenting to the emergency room with pharyngitis and fever. Blood cultures were drawn and Arcanobacterium haemolyticum (rough biotype) was recovered. The presence of the arcanolysin gene was investigated at the molecular level and the upstream region was amplified and sequenced in order to correlate it with the smooth or rough biotype. Although the isolate was susceptible to penicillin, vancomycin and gentamicin, empirical treatments first with amoxicillin/clavulanic acid (1g/12h) and then with ceftriaxone (1g/12h) failed and the infection evolved to sepsis. Finally, treatment with vancomycin (1 g/12 h) plus piperacillin/tazobactam (4.5g/8h) was effective. Lemierre's syndrome was ruled out. To the best of our knowledge, this is the first case of bacteremia by A. haemolyticum reported in Argentina.

Resumen Se describe el caso de un paciente varón inmunocompetente de veinte anos de edad que se presentó en la sala de emergencias con faringitis y fiebre. Se extrajeron muestras para realizar hemocultivos y se recuperó Arcanobacterium haemolyticum (biotipo rugoso). Se investigó la presencia del gen de la arcanolisina por un método molecular, y se amplificó y Faringitis; secuenció la región upstream de dicho gen para determinar su correlación con los biotipos lisos Bacteriemia; o rugosos. Aunque el aislamiento fue sensible a la penicilina, la vancomicina y la gentamicina, Sepsis; los tratamientos empíricos primero con amoxicilina/ácido clavulánico (1 g/12 h) y luego con Síndrome de Lemierre ceftriaxona (1 g/12 h) no fueron efectivos, y la infección evolucionó a sepsis. Finalmente, el tratamiento con vancomicina (1 g/12 h) más piperacilina/tazobactam (4,5g/8h) fue efectivo. Se descartó la presencia del síndrome de Lemierre. Según nuestro conocimiento, este es el primer caso de bacteriemia por A. haemolyticum reportado en Argentina.

Bacteremia and sepsis by Arcanobacterium haemolyticum in a young immunocompetent patient.

We report the case of a twenty-year-old immunocompetent male patient presenting to the emergency room with pharyngitis and fever. Blood cultures were drawn and Arcanobacterium haemolyticum (rough biotype) was recovered. The presence of the arcanolysin gene was investigated at the molecular level and the upstream region was amplified and sequenced in order to correlate it with the smooth or rough biotype. Although the isolate was susceptible to penicillin, vancomycin and gentamicin, empirical treatments first with amoxicillin/clavulanic acid (1g/12h) and then with ceftriaxone (1g/12h) failed and the infection evolved to sepsis. Finally, treatment with vancomycin (1g/12h) plus piperacillin/tazobactam (4.5g/8h) was effective. Lemierre's syndrome was ruled out. To the best of our knowledge, this is the first case of bacteremia by A. haemolyticum reported in Argentina.

Epidemiología de la faringitis aguda bacteriana en un hospital general de agudos / Epidemiology of acute bacterial pharyngitis in a general acute care hospital / Epidemiologia da faringite bacteriana aguda em um hospital geral de cuidados agudos

La faringitis aguda bacteriana (FAB) representa entre un 20 a 30% de las faringitis. El principal agente causal es Streptococcus pyogenes. Se revisó retrospectivamente la información microbiológica disponible entre 2010 y 2016, para analizar la incidencia de la FAB, sus agentes causales, la incidencia de casos según el período estacional y rango etario. Se determinó el porcentaje de resistencia (R) de S. pyogenes a eritromicina y el fenotipo predominante. Se diagnosticó FAB en 21,5% de 3.246 cultivos, donde 89% fueron causados por S. pyogenes. El 35,3% de las FAB se presentó en niños de 7 a 10 años, seguido por el grupo de mayores de 15 años (31,3%). Se evidenció un aumento de faringitis por Streptococcus dysgalactiae subsp. equisimilis en 2011 y 2014; 56,2% de los casos se diagnosticaron en mayores de 15 años. Hubo 3 casos de FAB por Arcanobacterium haemolyticum. El 36,1% de las faringitis se presentaron en primavera, con un aumento significativo durante las correspondientes a 2010 y 2016. La R global a eritromicina en S. pyogenes fue del 16,6% con predominio del fenotipo M. El valor de R encontrado fue superior al ser comparado con otras estadísticas similares, lo que demostró la importancia de monitorear este dato, dado que es el antibiótico alternativo en pacientes alérgicos a penicilina.

Acute bacterial pharyngitis (ABP) accounts for 20 to 30% of acute pharyngitis. The most common bacterial agent is Streptococcus pyogenes. A retrospective, record-based study was carried out based on the microbiological records from 2010 to 2016, analyzing ABP's incidence, its causal agents and its incidence according to the season and age range. Erythromycin resistance and the main resistance phenotype were determined in S. pyogenes. Acute bacterial pharyngitis was diagnosed in 21.5% out of 3.246 cultures, 89% were due to S. pyogenes, 36.3% of patients were children between 7 to 10 years old and 31.3% were older than 15 years of age. There was a significant increase in pharyngitis due to Streptococcus dysgalactiae subsp. equisimilis since 2010 (p<0.05), 52.5% were detected in patients older than 15 years of age. There were only three cases of ABP produced by Arcanobacterium haemolyticum. A total of 36.1% of pharyngitis occurred during spring, with a significant increase during 2010 and 2016 springs. Global erythromycin resistance in S. pyogenes was 16.6% with predominance of the M phenotype. This resistance rate is higher than that described in other similar series, demonstrating the importance of continuously monitoring of macrolide R in S. pyogenes, since they are the antibiotics of choice to treat pharyngitis in patients allergic to penicillin.

A faringite bacteriana aguda (FAB) representa entre 20 e 30% das faringites. O principal agente causador é Streptococcus pyogenes. Foi revista retrospectivamente a informação microbiológica disponível entre 2010 e 2016, para analisar a incidência da FAB, seus agentes causadores, a incidência de casos de acordo com o período sazonal e a faixa etária. A percentagem de resistência (R) de S. pyogenes à eritromicina e ao fenótipo predominante foram determinadas. Foi diagnosticado FAB em 21,5% de 3,246 culturas, 89% das quais foram causadas por S. pyogenes. 35,3% das FAB se apresentou em crianças de 7 a 10 anos, seguidas pelo grupo de mais de 15 anos (31,3%). Houve aumento de faringite por Streptococcus dysgalactiae subsp. equisimilis em 2011 e 2014; 56,2% dos casos foram diagnosticados em jovens de mais de 15 anos. Houve 3 casos de FAB por Arcanobacterium haemolyticum. 36,1% das faringites ocorreu na primavera, com um aumento significativo em 2010 e 2016. A R global a eritromicina em S. pyogenes foi de 16,6% com prevalência do fenótipo M. O valor de R encontrado foi superior em comparação com outras estatísticas semelhantes, demonstrando a importância de monitorar esse dado, pois é o antibiótico alternativo em pacientes alérgicos à penicilina.

Virulence markers associated with Trueperella pyogenes infections in livestock and companion animals.

Trueperella pyogenes is an opportunistic pathogen that causes diverse pyogenic infections in livestock. The genes that encode the exotoxin pyolysin (plo) and other putative factors that promote adhesion of pathogen to host cells (fimbriae fimA, fimC, fimE, fimG, neuraminidases nanH, nanP, and collagen-binding protein cbpA) have been associated with virulence, particularly in mastitis and uterus infections of dairy cows. However, the role of these virulence markers in the pathogenicity of the agent in domestic animals infections still is incompletely understood. The genes plo, fimA, fimC, fimE, fimG, nanH, nanP, and cbpA were investigated in 71 T. pyogenes strains recovered from cattle, sheep, goats, dogs, equines, and a pig, recovered from mastitis (n = 35), and non-mastitis (n = 36) cases (abscesses, reproductive tract diseases, pneumonia, lymphadenitis, encephalitis). The most common genes harboured by the isolates were: plo (71/71 = 100·0%), fimA (70/71 = 98·6%), nanP (56/71 = 78·9%), fimE (53/71 = 74·6%), fimC (46/71 = 64·8%) and nanH (45/71 = 63·4%), whereas cbpA (6/71 = 8·4%) and fimG (4/71 = 5·6%) were uncommon. The most frequent genotypes were plo/fimA/fimE/fimC/nanH/nanP (17/71 = 23·9%), plo/fimA/fimE/nanH/nanP (13/71 = 18·3%), and plo/fimA/fimE/fimC/nanP (11/71 = 15·5%). No association was observed between the presence of genes vs clinical signs or host species. To the best of our knowledge, this is the first report on aforementioned virulence factors of pathogen detected in diseased horses and dogs. SIGNIFICANCE AND IMPACT OF THE STUDY: The role of particular virulence factors of Trueperella pyogenes that determine different pyogenic infections among domestic animals is poorly understood. Eight putative virulence genes and genotype profiles of 71 isolates were investigated among different clinical manifestations in domestic animals. The most common genes were plo (71/71 = 100·0%), fimA (70/71 = 98·6%), nanP (56/71 = 78·9%), fimE (53/71 = 74·6%), fimC (46/71 = 64·8%) and nanH (45/71 = 63·4%), whereas plo/fimA/fimE/fimC/nanH/nanP (17/71 = 23·9%), plo/fimA/fimE/nanH/nanP (13/71 = 18·3%), and plo/fimA/fimE/fimC/nanP (11/71 = 15·5%) were the most frequent genotypes. Studies involving virulence factors are critical in the investigation of molecular epidemiology, pathogenicity, and hypothetical differences in the virulence among T. pyogenes strains from different geographical areas.

Unusual caudal vena cava thrombosis in a cow, secondary to Trueperella (Arcanobacterium) pyogenes infection / Rara trombose da veia cava caudal em bovino, secundária à infecção por Trueperella (Arcanobacterium) pyogenes

The caudal vena cava thrombosis, or pulmonary thromboembolism, in cattle is correlated with lactic acidosis, caused by diets rich in grains and highly fermentable, associated or not to septic situations, used in feedlots of beef or high-producing dairy cattle. This paper reports an unusual caudal vena cava thrombosis in a cow, secondary to Trueperella (Arcanobacterium) pyogenes infection, resulting in reduced milk production, anorexia, pale mucous membranes, ruminal atony, sternal decubitus and autoauscultation position. The heart was enlarged at necropsy, presence of clots distributed along the thoracic cavity, adherence between lung and pleura, abscesses, emphysema, petechiae, suffusions and ecchymosis in lungs, thickening of the caudal vena cava wall, hepatomegaly with chronic passive congestion ("nutmeg" aspect), and rumenitis. In lab, the actinomycete Trueperella (Arcanobacterium) pyogenes was isolated from liver and lung samples, probably resulting through dissemination of the bacteria of the rumen content, what reaffirms the opportunistic behavior of this actinomycete.(AU)

A síndrome da veia cava caudal ou tromboembolismo pulmonar bovino está relacionada à acidose láctica causada por dietas ricas em grãos e altamente fermentáveis, associados ou não a quadros sépticos, usadas em confinamentos de bovinos de corte ou para vacas leiteiras de alta produção. O presente artigo reporta caso raro de trombose da veia cava caudal em uma vaca, secundária a infecção por Trueperella (Arcanobacterium) pyogenes, apresentando reduzida produção de leite, anorexia, palidez de mucosas, atonia ruminal, decúbito esternal e posição de autoauscultação. À necrópsia observou-se coração aumentado de tamanho, coágulos distribuídos por toda cavidade torácica, aderência entre os pulmões e pleura, abscessos, enfisema, petéquias, sufusões, equimoses nos pulmões, espessamento da parede da veia cava caudal com trombo, hepatomegalia com congestão passiva crônica (aspecto de "noz moscada"), e ruminite. Em laboratório isolou-se o actinomiceto Trueperella (Arcanobacterium) pyogenes a partir de amostras de fígado e pulmão, provavelmente resultando da disseminação da bactéria proveniente do conteúdo ruminal, e reafirma o comportamento oportunista deste actinomiceto.(AU)

Trueperella pyogenes multispecies infections in domestic animals: a retrospective study of 144 cases (2002 to 2012).

BACKGROUND: Formerly, Arcanobacterium pyogenes was recently renamed Trueperella pyogenes. This opportunistic bacterium is related to miscellaneous pyogenic infections in animals. Most studies involving T. pyogenes are case reports, whereas few surveys have focused the major aspects of T. pyogenes infections involving a case series study design. OBJECTIVE: The aim of this study was to retrospectively evaluate selected epidemiological and clinical aspects, as well as the in vitro antimicrobial susceptibility pattern of 144 cases of T. pyogenes infections among domestic animals from 2002 to 2012. ANIMALS AND METHODS: T. pyogenes was isolated from different clinical specimens from cattle, goats, sheep, pigs, horses, dogs, and buffaloes. Correlations were assessed by the Chi-square or Fisher's exact tests. RESULTS: Mastitis (45.1%), abscesses (18.0%), pneumonia (11.1%), and lymphadenitis (9.0%) were the most common clinical manifestations. In addition, the organism was also isolated from other miscellaneous clinical specimens from cases of septicemia, encephalitis, pyometra, prostatitis, orchitis, seminal vesiculitis, pericarditis, and omphalitis. No statistical association was observed between T. pyogenes infections and age, gender, or season across the study. The most effective drugs against the pathogen were florfenicol (99.1%), cefoperazone (96.0%), cephalexin (95.0%), and ceftiofur (94.8%). High resistance rates were observed against trimethoprim-sulfamethoxazole (49.3%), followed by norfloxacin (10.9%) and tetracycline (9.2%). CONCLUSIONS: This study highlights the diversity of clinical manifestations and the opportunistic behavior of T. pyogenes infections in domestic animals, with predominance of mastitis, abscesses, pneumonia, and lymphadenitis. It also reinforces the importance of knowing the susceptibility profile before initiating therapy, to improve antimicrobial therapy approaches.

Deforming mandibular osteomyelitis in a cow caused by Trueperella pyogenes / Osteomielite mandibular deformante em vaca causada por Trueperella pyogenes

This study reports an unusual case of deforming mandibular osteomyelitis in a cow caused by Trueperella (Arcanobacterium) pyogenes, on the face of the ventrolateral caudal portion of the right branch of the mandible. Fragment aspired of lesion by fine needle allowed cytological characterization, isolation and identification of T. pyogenes. Radiographic examination showed marked periosteal reaction in the right mandible, numerous lytic areas and cortical bone destruction. Despite of treatment based on in vitro antimicrobial sensitivity test, it was recommended the euthanasia due to progressive worsening of the cow's condition. Multiple abscesses were observed in the mandibular region at necropsy. Pyogranuloma was characterized in histological exam. Sampled material collected from the lesion after necropsy resulted in microbiological reisolation of T. pyogenes.(AU)

Relata-se caso incomum de osteomielite mandibular deformante em vaca, causada por Trueperella (Arcanobacterium) pyogenes, na face ventro-lateral da porção caudal do ramo direito da mandíbula. A punção aspirativa de fragmento da lesão permitiu a caracterização citológica, o isolamento microbiano e identificação de T. pyogenes. Exame radiográfico mostrou acentuada reação periodontal na mandíbula direita, com predomínio de áreas líticas e destruição da cortical óssea. Apesar da instituição do tratamento baseado no teste de sensibilidade microbiana in vitro, foi recomendada a eutanásia, em virtude da piora progressiva do estado geral do animal. No exame post-mortem foram observados múltiplos abscessos na lesão que, histologicamente, foi caracterizada como piogranuloma. A colheita de material da região mandibular afetada, após a necropsia, resultou no reisolamento microbiológico de T. pyogenes.(AU)

Antimicrobial activity of copper (ii) complex with 1, 2-bis [(1, 3-diphenylpyrazol-4-yl)methyl] diaminoethane

Background: Multi-resistant strains multiply daily, populate farms, hospitals and other ecological niches around the world, and cause serious infections in animals and humans, often leading to a fatal outcome. Researchers of all profiles are investigating intensively to find new substances with antimicrobial activity. In the period between 1981 and 2002, 163 new chemical compounds were approved for use as drugs. Synthesized compounds have become much more interesting than the natural ones in the production of new antimicrobial agents. Some of these synthesized compounds are Copper (II) complex. The antimicrobial properties of copper were known in ancient Egypt (2000 BC), where it was used to sterilize water and wounds. Copper is still interesting for today's research. Materials, Methods & Results: Antimicrobial activity was tested using a microdilution method according to Clinical and Laboratory Standards Institute. The percentage of surviving bacteria was calculated in comparison to the number of bacteria placed in each well. Based on these results, using the Excel software package from Microsoft Office 2007, graphs were generated that showed the percentage of surviving bacteria depending on the corresponding effective concentrations of the tested substance. The function, which was used to approximate the experimental results, was determined using the Power Trendline supplement from the Microsoft Excel program. Cytotoxicity (growth inhibition) was evaluated by tetrazolium colorimetric MTT assay, after exposure of cells to the tested compound for 48 h. Inhibition of growth was expressed as a percentage of cytotoxicity and calculated according to the following equation: (1-A test/A control) x 100. MBC99.9 and MIC99 of the test substance were lowest for Arcanobacterium haemolyticum being 0.2 mg/L and 0.0054 mg/L, respectively. The highest values were obtained for Arcanobacterium pyogenes and methicillin-resistant Staphylococcus aureus (MRSA) 488.002 mg/L and 20.2 mg/L. MIC80 for all four strains ranged from 0.00002 to 0.0023 mg/L. Measured values for MIC99 are 0.00545 mg/L for A. haemolyticum, 0.0443199 mg/L for R. equi, 0.0520712 mg/L for S. aureus and 2.36378 mg/L for A. pyogenes. Values for MIC99.9 ranged from 0.236134 to 488,002 mg/L. Most of the MIC values obtained in this study are significantly lower than those reported by other researchers. The values we obtained were lower as compared to MIC values for standard antibiotics, which were considered acceptable by the relevant institutions. This speaks in favor of a stronger antibacterial effect of our tested substances. In regards to cytotoxicity, the obtained MIC80 doses were lower than toxic, whereas MIC90 could be classified as low-toxic (less than 0.0625 µM), except of Arcanobacterium pyogenes only. According to the IC50 values, the compound Cu (L) Br2·MeOH was 6.4-fold and 4.8-fold more potent against HCT116 cells compared to normal lung fi broblasts and SW620 cells, respectively. Discussion: Copper (II) complex with an arylpyrazole ligand exhibits strong antibacterial properties, and it shows bacteriostatic effect at concentrations where there is no cytotoxic effect in normal human cells. The emergence of multi-resistant strains of pathogenic bacteria is a growing problem worldwide. Therefore, each new compound with potential antimicrobial activity, especially if it is not cytotoxic in effective dosage, deserves the attention of the scientific community. In this paper, we presented a newly synthesized substance with such properties.

Mastite clinica caprina causada por Arcanobacterium pyogenes / Clinical mastitis in goat due to Arcanobacterium pyogenes

This paper reports the occurrence of goat mastitis due to Arcanobacterium pyogenes in Paraiba State - Brazil. The diagnosis was confirmed by clinical symptoms and microbiological culture. Amastectomywasperformedasclinical treatment.

Evaluación citológica y microbiológica de lavados uterinos en bovinos con problemas reproductivos (estudio preliminar) / Cytological and microbiological evaluation of uterine washing of bovine with reproductive problems (preliminary study)

Objetivo. Determinar las características citológicas y microbiológicas de lavados uterinos de bajo volúmen en hembras con problemas reproductivos en dos hatos del Altiplano Cundiboyacense. Materiales y métodos. Se evaluaron 21 muestras de lavados uterinos de vacas con historia de problemas reproductivos procedentes de dos hatos lecheros, en el primer hato ubicado en Sibaté (Cundinamarca) se muestrearon 10 animales y en el segundo ubicado en Ventaquemada (Boyacá) se obtuvieron las 11 muestras restantes. Se realizó evaluación macroscópica y microscópica de cada uno de los lavados uterinos; para la evaluación citológica se utilizaron las tinciones de Gram y Wright. La determinación de la flora bacteriana se realizó mediante técnicas estándar en microbiología para la identificación de bacterias no exigentes, adicionalmente se realizaron pruebas de sensibilidad por la técnica de difusión de Kirby-bauer. Resultados. En la citología se observaron bacilos y cocos gram positivos, células epiteliales de descamación uterina (CEDU) y respuesta inflamatoria (RI) mediada por polimorfonucleares (PMN). Los aislamientos bacterianos correspondieron a Lactobacillus sp como flora bacteriana normal del tracto genital (16.66%) y Klebsiella sp como flora acompañante (16.66%); adicionalmente se aislaron bacterias patógenas causantes de problemas reproductivos como Streptococcus sp. β hemolítico (33.33%), Streptococcus sp α hemolítico (50%) y Streptococcus sp. γ hemolítico (50%) y Arcanobacterium pyogenes (Corynebacterium-Actinomyces pyogenes) (16.66%); en un 9.52% de las muestras se observaron espiroquetas. Conclusiones. Se observó una relación directa entre el aspecto macroscópico de los lavados uterinos, la respuesta citológica y el aislamiento de bacterias.