Chapter 131. Diphtheria and Other Infections Caused by Corynebacteria and Related Species (Part 7) pdf

Diphtheria and Other Infections Caused by Corynebacteria and Related Species Part 7 Other Nondiphtherial Corynebacteria C.. xerosis is a human commensal found in the conjunctiva, naso

Chapter 131 Diphtheria and Other Infections Caused by

Corynebacteria and Related Species

(Part 7)

Other Nondiphtherial Corynebacteria

C xerosis is a human commensal found in the conjunctiva, nasopharynx,

and skin This nontoxigenic organism is occasionally identified as a source of invasive infection in immunocompromised or postoperative patients and prosthetic

joint recipients C striatum is found in the anterior nares and on the skin, face, and

upper torso of normal individuals Also nontoxigenic, this organism has been associated with invasive opportunistic infections in severely ill or

immunocompromised patients C amycolatum is a new species isolated from

human skin and is identified on the basis of a unique 16S ribosomal RNA

sequence associated with opportunistic infection C glucuronolyticum is a new

nonlipophilic species that causes male genitourinary tract infections such as prostatitis and urethritis These infections may be successfully treated with a wide variety of antibacterial agents, including β-lactams, rifampin, aminoglycosides, or vancomycin; however, the organism appears to be resistant to fluoroquinolones,

macrolides, and tetracyclines C imitans has been identified in Eastern Europe as

a nontoxigenic cause of pharyngitis C auris has been isolated from children with

otitis media and is susceptible to fluoroquinolones, rifampin, tetracycline, and

vancomycin but resistant to penicillin G and variably susceptible to macrolides C

pseudodiphtheriticum (C hofmannii) is a nontoxigenic component of the normal

human flora Human infections—particularly endocarditis of either prosthetic or native valves and invasive pneumonia—have been identified only rarely Although

C pseudodiphtheriticum may be isolated from the nasopharynx of patients with

suspected diphtheria, it is part of the normal flora and does not produce diphtheria

toxin C propinquum, a close relative of C pseudodiphtheriticum, is part of CDC

Group ANF-3 and is isolated from human respiratory tract specimens and blood

C afermentans subspecies lipophilum belongs to CDC Group ANF-1 and has been

isolated from human blood and abscess infections C accolens has been isolated

from wound drainage, throat swabs, and sputum and is typically identified as a

satellite of staphylococcal organisms; it has been associated with endocarditis C

bovis is a veterinary commensal that has not been clearly identified as a cause of

human disease C aquaticum is a water-associated organism that is occasionally

isolated from patients using medical devices (e.g., for chronic ambulatory peritoneal dialysis or venous access)

Rhodococcus

Rhodococcus species are phylogenetically related to the corynebacteria

These gram-positive coccobacilli have been associated with tuberculosis-like

infections in humans with granulomatous pathology Although R equi is best known, other species have been identified, including R (also Gordonia)

bronchialis, R (also Tsukamurella) aurantiacus, R luteus, R erythropolis, R rhodochrous, and R rubropertinctus R equi has been recognized as a cause of

pneumonia in horses since the 1920s; it causes related infections in cattle, sheep,

and swine R equi is found in soil as an environmental microbe The organisms

vary in length; appear as spherical to long, curved, clubbed rods; and produce

large, irregular mucoid colonies R equi does not ferment carbohydrates or liquefy gelatin and is often acid fast An intracellular pathogen of macrophages, R equi

can cause granulomatous necrosis and caseation The organism has been identified most commonly in pulmonary infections, but infections of brain, bone, and skin

have also been reported Most commonly, R equi disease manifests as nodular

cavitary pneumonia of the upper lobe—a picture similar to that seen in tuberculosis or nocardiosis Most patients are immunocompromised, often with HIV infection Subcutaneous nodular lesions have also been identified The

involvement of R equi should be considered in any patient presenting with a tuberculosis-like syndrome Infection due to R equi has been treated successfully

with antibiotics that penetrate intracellularly, including macrolides, clindamycin, rifampin, and trimethoprim-sulfamethoxazole β-Lactam antibiotics have not been

useful The organism is routinely susceptible to vancomycin, which is considered the drug of choice

Actinomyces pyogenes

A cause of seasonal leg ulcers in humans in rural Thailand, A pyogenes is a

well-known pathogen of cattle, sheep, goats, and pigs A few human cases of sepsis, endocarditis, septic arthritis, pneumonia, meningitis, and empyema have been reported The agent is susceptible to β-lactams, tetracycline, aminoglycosides, and fluoroquinolones

Arcanobacterium haemolyticum

A haemolyticum was identified as an agent of wound infections in U.S

soldiers in the South Pacific during World War II This organism appears to be a commensal of the human nasopharynx and skin but has been implicated as a cause

of pharyngitis and chronic skin ulcers In contrast to the much more common

pharyngitis caused by Streptococcus pyogenes, A haemolyticum pharyngitis is

associated with a scarlatiniform rash on the trunk and proximal extremities in about half of cases; this illness is occasionally confused with toxic shock

syndrome Because A haemolyticum pharyngitis primarily affects teenagers, it has

been postulated that the rash-pharyngitis syndrome may represent copathogenicity

or synergy with EBV or opportunistic secondary infection complicating EBV

infection A haemolyticum has also been reported as a cause of bacteremia, soft

tissue infection, osteomyelitis, and cavitary pneumonia, predominantly in the setting of underlying diabetes mellitus The organism is susceptible to β-lactams, macrolides, fluoroquinolones, clindamycin, vancomycin, and doxycycline Penicillin resistance has been reported

Further Readings

Centers for Disease Control and Prevention: Availability of diphtheria antitoxin through an investigational new drug protocol MMWR 53:413, 2004

———: Vaccine preventable deaths and the Global Immunization Vision and Strategy, 2006–2015 MMWR 55:511, 2006

Dittmann S et al: Successful control of epidemic diphtheria in the states of the former Union of Soviet Socialist Republics: Lessons learned J Infect Dis 181(Suppl 1):S10, 2000

Holmes RK: Biology and molecular epidemiology of diphtheria toxin and the tox gene J Infect Dis 181(Suppl 1):S156, 2000

Kadirova R et al: Clinical characteristics and management of 676 hospitalized diphtheria cases, Kyrgyz Republic, 1995 J Infect Dis 181(Suppl

1):S110, 2000

Kretsinger K et al: Preventing tetanus, diphtheria, and pertussis among adults: Use of tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine; recommendations of the Advisory Committee on Immunization Practices (ACIP) and recommendation of ACIP, supported by the Healthcare Infection Control Practices Advisory Committee (HICPAC), for use of Tdap among health-care personnel MMWR Recomm Rep 55(RR-17):1, 2006

MacGregor RR: Corynebacterium diphtheriae, in Principles and Practice

of Infectious Diseases, 6th ed, GL Mandell et al (eds) Philadelphia, Elsevier

Churchill Livingstone, 2005, pp 2457–2465

McNeil SA et al: Comparison of the safety and immunogenicity of concomitant and sequential administration of an adult formulation tetanus and diphtheria toxoids adsorbed combined with acellular pertussis (Tdap) vaccine and trivalent inactivated influenza vaccine in adults Vaccine 25:3464, 2007; Epub

2007 Jan 9

Meyer DK, Reboli AC: Other coryneform bacteria and Rhodococcus, in

Principles and Practice of Infectious Diseases, 6th ed, GL Mandell et al (eds)

Philadelphia, Elsevier Churchill Livingstone, 2005, pp 2465–2478

Pichichero ME et al: Combined tetanus, diphtheria, and 5-component pertussis vaccine for use in adolescents and adults JAMA 293:3003, 2005 [PMID: 15933223]

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Galazka A: Implications of the diphtheria epidemic in the former Soviet Union for immunization programs J Infect Dis 181(Suppl 1):S244, 2000

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