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Brevibacterium massiliense bacteremia
Maude Vecten, Frederique Gouriet, Aline Cano, Didier Raoult
To cite this version:
Maude Vecten, Frederique Gouriet, Aline Cano, Didier Raoult. Brevibacterium massiliense
bac-teremia. IDCASES, 2017, 7, pp.25-26. �10.1016/j.idcr.2016.11.010�. �hal-01774352�
Case
report
Brevibacterium
massiliense
bacteremia
Maude
Vecten
a,b,
Frédérique
Gouriet
a,b,*
,
Aline
Cano
c,
Didier
Raoult
a,baUnitédeRecherchesurlesMaladiesInfectieusesetTropicalesEmergentes,UM63,UMRCNRS7278,IRD198,Inserm1095,Aix-MarseilleUniversité,Faculté
deMédecine,13385Marseille,France
b
PôledeMaladiesInfectieuses,HôpitaldelaTimone,RueStPierre,13385MarseilleFrance
c
CentredeRéférencedesMaladiesHéréditairesduMétabolisme-ServicePrCHABROL,CHULaTimoneEnfants,RueStPierre,13385Marseille,France
ARTICLE INFO
Articlehistory:
Received15September2016
Receivedinrevisedform22November2016 Accepted22November2016
Keywords: Bacteremia Brevibacteriumsp.
ABSTRACT
Brevibacteriummassilienseinfectioninmanisrare.WereportherethesecondcasewithisolationofB. massilienseinhuman.Thismicro-organismrequiresspecificlaboratoryinvestigationssuchas16SrRNA genesequencingforaccuratespeciesidentification.Theclinicaloutcomewasfavorable.
©2016TheAuthors.PublishedbyElsevierLtd.ThisisanopenaccessarticleundertheCCBY-NC-ND license(http://creativecommons.org/licenses/by-nc-nd/4.0/).
Casepresentation
In December 2015, a 4-year-old boy was admitted to the pediatricneurologyunitofTimonePediatricHospital,Marseille, Franceforfever.
Thepatientisfollowedinthecenterofreferenceformetabolical disease because of a methylmalonic acidemia (withC.844C>G mutationhomozygousintheMUTgene)diagnosedwhenhewas 8monthsoldin acontextofmetabolicacidosisandpreexisting hypotonia, during an intercurrent illness. Because of feeding difficultiesduetohismetabolicaldisease,agastrostomytubewas placedwhenhewas2yearsold.Thetreatmentofhismetabolical disease consist of a protein restricted diet, with hypercaloric nutritionandantimicrobialtherapywithmetronidazole3weeks per month to reduce propionic acid formation (a source of intoxicationinthisdisease)bygutflora.
Beforehospitalization,hesawhisgeneralpractitionerforfever, coughandvomitingfor4days,whoprescribedcefiximeorally.On admissionhisphysicalexamshowsonlycongestiveeardrumsand a dischargeof leftear withoutpharyngitis. Bloodtest included CRP=0.59mg/dL, white blood cells=9400
m
L, platelets: 363,000m
L;creatine:37m
mol/L, urea:3.5mmol/l, ASAT:74UI/L, ALAT:32UI/L,oxalemia:0.020mmol/l,HCO3:22.4mmmol/l.The oral cefixime was stopped, and intra-auricular ofloxacin was prescribedfor8days.After3daysinhospital,hereturnedtohomewith no symptoms. The blood culture (pediatric blood culture BACTEC;BectonDickinson,Sparks,MD)performedonadmission was positive after 72h of culture with Gram positive bacilli. TheGram-positive bacillus was isolated but no phenotypic identification was obtained by MicroFlex mass spectrometer (Bruker Daltonics, Bremen, Germany). Molecular identification basedon16srRNAgenesequencecomparisonwasperformed[6]
andshowedthattheisolatewasBrevibacteriummassiliensewith 99.60% of similarity with the genbank sequence NR116479. Susceptibility of the strain was tested using thedisk diffusion methodonMueller-Hintonagarplatesincubatedat37Cfor24h. Ourisolatewassusceptibletoamoxicillin,amoxicillinclavulanic acid,cefixime,imipenem,ofloxacinandvancomycin.Themother wascontacted,andtheboyhadnofeverandwasinagoodhealthy state.Nomoreantimicrobialswereprescribed.
WereportherethesecondcaseofisolationwithB.massiliense inhuman,inbloodculture.B.massiliensewasisolatedandthisnew specieswasdescribedforthefirsttimein2009[8]andhisdraft genome sequence was performed in 2012 [9]. The strain was isolatedfromanankledischargeobtainedfromapatientwithopen dislocationontheleftankleandafibulafracture[8]. Brevibacte-riumspecies areGrampositive bacilli,non-spore-forming, non-branchingrods.ThegenusBrevibacteriumconsistsof50different species.Ninespecieshavebeenisolatedfromhuman:B.caseiisthe mostfrequenthumanisolate,B.epidermidis,B.otitidis,B. paucivor-ans, B. sanguinis, B. linens, B. iodinum, B. mcbrellneri, and B. massiliense[8,9].Brevibacteriumspp.havebeenisolatedfromdairy product(rawmilkandsurface-ripenedcheeses)anditispartof normalhumanskin[4].Intheliterature,Brevibacteriumhavebeen isolatedfromhuman.Brevibacteriumsp.havebeenimplicatedin several infections such as peritonitis [1], bacteremia [4], bone
* Correspondingauthorat:UnitédeRecherchesurlesMaladiesInfectieuseset TropicalesEmergentes,UM 63, UMRCNRS7278,IRD 198,Inserm 1095, Aix-MarseilleUniversité,FacultédeMédecine,27BlvdJeanMoulin,13385,Marseille, cedex05,France.
E-mailaddress:[email protected](F.Gouriet).
http://dx.doi.org/10.1016/j.idcr.2016.11.010
2214-2509/©2016TheAuthors.PublishedbyElsevierLtd.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).
IDCases7(2017)25–26
ContentslistsavailableatScienceDirect
IDCases
infection [7,8], pericardial infection [2], endocarditis [3], brain abscess [5]. These organisms have emerged as opportunistic pathogens in most reported cases; patients had underlying malignancyorimmunodeficiencydisease[10].
Conclusion
PhenotypicmethodfailedintheidentificationofB.massiliense onlythe16SrRNAgenesequencingallowedtoidentifiedthestrain. Misidentificationinroutinemicrobiologylaboratoryconducesto underestimationofsuchrelevantbacteriaandmayconsiderably impact the diagnosis of emerging pathogens. Therefore, it is important tosensitize microbiologists toidentify this environ-mentalbacteriausingthe16SrRNAgenesequencing.
Consent
Written consent was obtainedfrom thepatient parent’s for publicationofthisCasereportandanyaccompanyingimages.A copyofthewrittenconsentisavailableforreviewbytheEditorof thisjournal.
Competinginterests None.
Authors'contributions
MVparticipatedtowritethemanuscript,FGparticipatedinthe designandcoordinationandhelpedtodraftthemanuscript,AC
managedthepatient,DRconceivedofthestudy.Allauthorsread andapprovedthefinalmanuscript.
Acknowledgments
WethankEmmanuelleBosdure,SophieEdouard,andBrigitte Chabrolforthepatientmanagement.
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