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5. Wormser GP, Horowitz HW, Dumer JS, containing 1% Tween 80 under aero- 1979 by Furness et al. (4) for Schwartz I, Aguero-Rosenfeld M. False- bic conditions (5% CO ). Colonies lipophilic corynebacteria isolated positive serology in human 2 granulocytic ehrlichiosis. Lancet. were white, opaque, smooth, convex, from urinary tract and was not consid- 1996;347:981–2. and nonhemolytic. This lipid-requir- ered a , in contrast to C. gen- ing strain was positive and italium. However, these 2 Address for correspondence: Emil C. Reisinger, strongly urease positive. Testing with were not included in the official list of Division for Tropical Medicine and Infectious the API-Coryne strip (bioMérieux, recognized species. Diseases, Department of Medicine, University Marcy l’Etoile, France) showed that C. pseudogenitalium was divided of Rostock Medical School, Ernst-Heydemann- the strain was nitrate-reduction posi- into 5 types based on biochemical pat- Str 6, D-18057 Rostock, Germany; fax: 49-381- tive and produced acid from glucose, terns, and strains of the type C-5 were 494-7509; email: [email protected] ribose, sucrose, and maltose. differentiated from other types on the rostock.de However, this strain, which was des- basis of urease production. The bio- ignated CCH052683, did not chemical and physiologic characteris- hydrolyze gelatin or esculin. It was tics of this C-5 type were similar of identified as Corynebacterium group those of the coryneform group F-1 F1 (the corresponding numeric profile described by the Centers for Disease of the gallery API-Coryne was Control and Prevention (CDC). In 3001325). 1995, a comprehensive study on Corynebacterium The strain was correctly identified lipophilic corynebacteria demonstrat- to the species level as Corynebac- ed by DNA-DNA hybridization the pseudogenitalium terium pseudogenitalium by using similarity between a reference strain Urinary Tract polymerase chain reaction and of C. pseudogenitalium type C-5 and sequencing 16 rRNA as previously reference strains of the CDC coryne- described (1,2). Comparison of 785 form group F-1 (1). The CDC group To the Editor: A 64-year-old man (546–1,331) gave a 16S F-1 make up 2 genomic groups at the was admitted to the urology depart- rDNA similarity value of 99.9% species level. As shown by 16S rDNA ment of Cochin Hospital in Paris, between the sequences of the isolated comparisons, isolate CCH0- France, for acute urinary retention. He strain and C. pseudogenitalium ATCC 52683 belongs to the genomic group, had a history of recurrent urolithiasis 33039/NCTC11860 (European Mole- including a reference strain of C. and undocumented urinary tract cular Biology Laboratory accession pseudogenitalium type C-5 ATCC symptoms. At admission, a urethral no. X81872). 33039 (CCUG 27540, sequence catheter was inserted, and a plain radi- The strain was sensitive to peni- X81872) and a reference strain of ograph showed 2 bladder stones and cillin, ampicillin, gentamicin, rifam- CDC group F-1 (CDC G4330, milk of calcium calcifications. Three pin, vancomycin, teicoplanin, tetracy- sequence X81905) (Figure). The other days later, he underwent extracorpo- cline, sulfamethoxazole, trimetho- genomic group of CDC group F-1 is real shock wave lithotripsy treatment, prim, , ciprofloxacin, and represented by strain CDC G5911 and empiric antimicrobial drug thera- norfloxacin and resistant to erythro- (sequence X81904). The molecular py with intravenous ceftriaxone, 1 mycin, lincomycin, and nitrofuran- genetic investigations identified our g/day for 3 days, was administered. toin. Ceftriaxone was replaced by nor- isolate as C. pseudogenitalium and Three consecutive urinalyses showed floxacin (400 mg twice a day) for 1 placed it in 1 of the 2 genomic groups a pH of 9, crystals of struvite, hema- month. The patient improved and of CDC group F-1, which cannot be turia, and 105 leukocytes/mL. Gram- remained healthy 6 months after ther- differentiated by biochemical tests positive rods with rounded ends and apy. (1). nonparallel sides, arranged in pal- Nondiphtheric corynebacteria are The pathogenicity of this bacteri- isades or in V shapes, were observed, of increasing importance. They have um was associated with strong urease which suggested the presence of been observed in human specimens, activity. This activity is similar to that corynebacteria. Urine cultures were and many new taxa of coryneform of other urease-positive microorgan- positive and yielded a pure culture of have been described (3). isms, such as C. urealyticum and 105 CFU/mL of Corynebacterium spp. Interest in their is increas- Proteus spp. (5,6), which infect the The isolated strain showed slight ing, and molecular, phenotypic, and urinary tract. Unfortunately, the blad- growth after 24 or 48 h of incubation biochemical analyses have resulted in der stones were not analyzed after on horse blood agar medium but the reclassification of this (3). extracorporeal shock wave lithotripsy abundant growth on the same medium C. pseudogenitalium was described in treatment. The C. pseudogenitalium

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 2, February 2006 355 LETTERS

Puumala Virus RNA in Patient with Multiorgan Failure To the Editor: The hantaviruses (genus Hantavirus, family Bunya- viridae) include human and occur worldwide (1). In Western and Central Europe, the predominant serotype is Puumala virus (PUUV), which causes epidemic nephropathy. We report the first Austrian patient Figure. Unrooted tree showing phylogenetic relationships of Corynebacterium pseudogen- italium CCH052683 and other members of the genus Corynebacterium. The tree was con- with reverse transcription–poly- structed by using the DNAstar program (DNAstar Inc., Madison, WI, USA) (Clustal merase chain reaction (RT-PCR)–con- method) and based on a comparison of 785 (546–1,331) nucleotides. European Molecular firmed PUUV infection and, to our Biology Laboratory sequence accession numbers are shown. The scale bar shows the knowledge, the first detection of percentage sequence divergence. Dotted line indicates a distant phylogenetic group for PUUV-specific RNA in bone marrow. which the scale is not applicable. On April 27, 2004, a previously healthy 52-year-old bus driver isolate was sensitive to most antimi- References stopped his bus because of visual dis- crobial drugs, particularly β-lactams, 1. Riegel P, Ruimy R, de Briel D, Prevost G, turbance, dizziness, headache, and aminoglycosides, and quinolones. Jehl F, Christen R, et al. Genomic diversity weakness in his legs; he then lost con- Thus, urinary tract caused and phylogenetic relationships among sciousness for a few minutes. He was by this species of bacteria respond lipid-requiring diphtheroids from humans seen at the neurology emergency serv- more readily to treatment than those and characterization of Corynebacterium macginleyi sp. nov. Int J Syst Bacteriol. ice and subsequently admitted to the caused by multidrug-resistant C. ure- 1995;45:128–33. university hospital in Graz. He alyticum (3). 2. Tang, YW, von Graevenitz A, Waddington smoked tobacco, drank beer on the In conclusion, we show that C. MG, Hopkins MK, Smith DH, Li H, et al. weekends, and cleaned his bus in the pseudogenitalium (CDC coryneform Identification of coryneform bacterial iso- lates by ribosomal DNA sequence analysis. garage daily. The patient showed group F-1) can cause urinary tract J Clin Microbiol. 2000;38:1676–8. slight paresis of the right leg, nystag- infection (7) and produce urease, and 3. Funke G, von Graevenitz A, Clarridge JE mus, cognitive deficit, and retrograde like C. urealyticum, cause stone for- III, Bernard KA. Clinical microbiology of amnesia. Laboratory tests showed mation in humans. Thus, urease-posi- coryneform bacteria. Clin Microbiol Rev. 1997;10:125–59. increases in (normal values are shown tive microorganisms isolated by uri- 4. Furness G, Sambury S, Evangelista AT. in parentheses) C-reactive protein nalysis that shows urinary alkaliniza- Corynebacterium pseudogenitalium sp. (CRP) 40 mg/L (<9), creatine kinase tion and struvite and pyuria crystal- nov. Commensals of the human male and (CK) 224 U/L (<170), lactate dehy- lization should be considered patho- female urogenital tracts. Invest Urol. 1979;16:292–5. drogenase (LDH) 244 U/L (<240), genic. Our results also confirm the 5. Digenis G, Dombros N, Devlin R, Rosa SD, and myoglobin 416 ng/mL (<90). difficulty in phenotypic identification Pierratos A. Struvite stone formation by Cerebrospinal fluid showed elevated of these strains and the need to use a Corynebacterium group F1: a case report. J protein of 60 mg/dL (<45) but no molecular approach to identify Urol. 1992;147:169–70. 6. Soriano F, Ponte C, Santamaria M, Castilla other abnormalities. Results of coryneform bacteria with clinical rel- C, Fernandez Roblas R. In vitro and in vivo computed tomographic scan of the evance. study of stone formation by Corynebac- terium group D2 (Corynebacterium ure- brain and chest radiograph were nor- Gérard Vedel,*† Gaëlle Toussaint,*† alyticum). J Clin Microbiol. 1986;23:691–4. mal. Because of increasing CRP (115 7. Soriano F, Ponte C. A case of urinary tract Philippe Riegel,‡ mg/L), empiric antimicrobial therapy infection caused by Corynebacterium ure- with pipera-cillin/tazobactam was Jean-Luc Fouilladieu,*† alyticum and coryneform group F1. Eur J started. During an electroencephalo- Annick Billöet,*† Clin Microbiol Infect Dis. 1992;11:626–8. and Claire Poyart*† gram on April 29, the patient deterio- *Groupe Hospitalier Cochin Saint-Vincent- Address for correspondence: Gérard Vedel, rated and was admitted to the inten- de-Paul La Roche-Guyon, Paris, France; Service de Bactériologie, Groupe Hospitalier sive care unit for respiratory failure †Université Paris René Descartes, Paris, Cochin Saint-Vincent-de-Paul La Roche- with a partial oxygen pressure of 40 France; and ‡Université Louis-Pasteur, Guyon, 75679 Paris, France; fax: 33-1-58-41- mm Hg; he required intubation and Strasbourg, France 15-48; email: [email protected]

356 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 12, No. 2, February 2006